A case-management system for coronary risk factor modification after acute myocardial infarction
R F DeBusk1, N H Miller, H R Superko
1Stanford University School of Medicine, CA.
Insights
A nurse-managed home-based case management system significantly improved coronary risk factor modification in patients after myocardial infarction compared to usual care. This intervention enhanced smoking cessation, lowered LDL cholesterol, and improved functional capacity.
Area of Science:
- Cardiology
- Preventive Medicine
- Health Services Research
Background:
- Coronary heart disease (CHD) management requires effective strategies for risk factor modification post-myocardial infarction (MI).
- Traditional care may not adequately address multiple risk factors in a coordinated manner.
- Home-based interventions can potentially improve patient adherence and outcomes.
Purpose of the Study:
- To assess the effectiveness of a physician-directed, nurse-managed, home-based case management system.
- To evaluate its impact on coronary risk factor modification in patients recovering from acute myocardial infarction.
- To compare this intervention against usual medical care.
Main Methods:
- A randomized clinical trial involving 585 patients (aged ≤70 years) hospitalized for acute MI across 5 Kaiser Permanente Medical Centers.
- Patients were assigned to either a special intervention group (n=293) or usual care (n=292).
- The intervention included hospital-initiated smoking cessation, exercise training, and diet-drug therapy for hyperlipidemia, followed by home-based telephone and mail contact.
Main Results:
- The intervention group achieved significantly higher cotinine-confirmed smoking cessation rates (70% vs. 53%, P=0.03).
- Plasma low-density lipoprotein cholesterol (LDL) levels were significantly lower in the intervention group (2.77 vs. 3.41 mmol/L, P=0.001).
- Functional capacity was significantly improved in the intervention group (9.3 vs. 8.4 METS, P=0.001).
Conclusions:
- A nurse-managed, home-based case management system is highly effective for coronary risk factor modification post-MI.
- This model of care demonstrates superior outcomes compared to usual medical care within a large health maintenance organization.
- The findings support the integration of such case management systems into routine cardiac care pathways.
Objective:
To evaluate the efficacy of a physician-directed, nurse-managed, home-based case-management system for coronary risk factor modification.
Design:
Randomized clinical trial in which patients received a special intervention (n = 293) or usual medical care (n = 292) during the first year after acute myocardial infarction.
Setting:
5 Kaiser Permanente Medical Centers in the San Francisco Bay area.
Patients:
585 men and women aged 70 years or younger who were hospitalized for acute myocardial infarction.
Intervention:
In the hospital, specially trained nurses initiated interventions for smoking cessation, exercise training, and diet-drug therapy for hyperlipidemia. Intervention after discharge was implemented primarily by telephone and mail contact with patients in their homes. All medically eligible patients received exercise training; all smokers received the smoking cessation intervention; and all patients received dietary counseling and, if needed, lipid-lowering drug therapy.
Outcome:
Smoking prevalence and plasma low-density lipoprotein cholesterol (LDL) concentrations were measured 2 months after infarction, and functional capacity was measured 6 months after infarction.
Results:
In the special intervention and usual care groups, the cotinine-confirmed smoking cessation rates were 70% and 53% (P = 0.03), plasma LDL cholesterol levels were 2.77 +/- 0.69 mmol/L and 3.41 +/- 0.90 mmol/L (107 +/- 30 mg/dL and 132 +/- 30 mg/dL) (P = 0.001), and functional capacities were 9.3 +/- 2.4 METS and 8.4 +/- 2.5 METS (P = 0.001), respectively.
Conclusion:
In a large health maintenance organization, a case-management system was considerably more effective than usual medical care for modification of coronary risk factors after myocardial infarction.
More Related Videos
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:26Coronary Artery Disease IV: Preventive Measures
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:20Angina V: Nursing Management