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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Interventions to maintain cardiac risk control after discharge from a cardiovascular risk reduction clinic: a
Tracey H Taveira1, Wen-Chih Wu1
1Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
Insights
Pharmacist-led cardiovascular risk reduction clinic (CRRC) maintenance strategies, including group and individual visits, significantly improve blood pressure and glycemia control in patients with diabetes compared to usual care.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Pharmacist-led cardiovascular risk reduction clinics (CRRCs) play a crucial role in managing chronic conditions.
- Effective post-discharge maintenance strategies are essential for sustained patient health outcomes.
- Evaluating different models of care is vital for optimizing cardiovascular risk management.
Purpose of the Study:
- To compare the efficacy of two post-discharge maintenance strategies against usual care.
- To assess the long-term effectiveness of pharmacist-led interventions in cardiovascular risk reduction.
Main Methods:
- An open-label, randomized-controlled trial involving 200 patients discharged from a CRRC.
- Participants were randomized to quarterly group medical visits, quarterly individual CRRC visits, or usual primary care.
- Primary outcomes measured were time to failure in achieving guideline-recommended HbA1c and blood pressure goals over 12 months.
Main Results:
- Both group and individual maintenance strategies showed significantly lower failure rates for HbA1c compared to usual care (p<0.001).
- Blood pressure control also demonstrated significantly lower failure rates in both intervention arms versus usual care (p<0.001).
- The quarterly CRRC individual arm exhibited the lowest failure rates for both HbA1c and blood pressure.
Conclusions:
- Post-discharge individual and group interventions from a CRRC are more effective than usual care for maintaining glycemic and blood pressure control.
- These findings support the continued use of structured follow-up programs for patients with diabetes.
- Pharmacist-led interventions demonstrate significant value in long-term cardiovascular risk management.
Aims:
To evaluate the efficacy of two maintenance strategies compared to usual care after discharge from a pharmacist-led cardiovascular risk reduction clinic (CRRC).
Methods:
Open-label, randomized-controlled trial of 200 consecutive CRRC patients that met clinic discharge criteria (HbA1c ≤7% (53 mmol/mol); blood pressure ≤140/80 mmHg for those with diabetes and ≤140/90 mmHg for those without diabetes; and an LDL-cholesterol ≤2.59 mmol/l). Participants were randomized to either quarterly group medical visits or quarterly CRRC individual clinic visits, or a usual care control arm with the standard primary care alone first in a 1:1:1 ratio, followed by a 2:2:1 ratio after first 100 patients. Primary outcome measures were time to failure for guideline recommended goals of HbA1c and blood pressure over 12-months.
Results:
Of the 200 participants randomized, 89% had diabetes and were similar in other cardiovascular risk factors. After 1-year, the HbA1c failure rate was 0.36 [95% CI, 0.28-0.47] per quarter for the group medical visit arm, 0.24 [95% CI, 0.18-0.33] per quarter for the quarterly CRRC individual arm and, 0.82 [95% CI, 0.69-0.96] per quarter for the usual care control arm, p<0.001. The rate of failure for blood pressure was 0.31 [95% CI, 0.23-0.41] per quarter for the group medical visit arm, 0.22 [95% CI, 0.16-0.30] per quarter for the CRRC individual arm and, 0.53 [95% CI, 0.40-0.71] per quarter the control arm, p<0.001.
Conclusion:
After discharge from a CRRC program, both individual and group interventions are more effective in maintaining glycemia and blood pressure control for patients with diabetes than usual care after 1-year of follow-up.
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