A cardiac prevention and rehabilitation programme for all patients at first presentation with coronary artery disease

Abstract

Objective-To develop and test a cardiac prevention and rehabilitation programme for achieving sustained lifestyle, risk factor, and therapeutic targets in patients presenting for the first time with exertional angina, acute coronary syndromes, or coronary revascularisation. Design-A descriptive study. Setting-A hospital based 12 week outpatient programme. Interventions-A multiprofessional family based programme of lifestyle and risk factor modification. Main outcome measures-Non-smoking status, body mass index, blood pressure, plasma cholesterol, use of prophylactic drugs. Results-158 patients (82% of 194 possible cases) were recruited over 15 months, with 72% completing the programme. Targets for achieving non-smoking status, blood pressure < 140/90 mm Hg, and total cholesterol < 4.8 mmol/l were achieved in 92%, 73%, and 62%, respectively, and the proportion on aspirin, blockers, and lipid lowering treatment was 95%, 58%, and 64% on referral back to general practice for continuing care. Conclusions-A comprehensive cardiac prevention and rehabilitation programme can be oVered to all patients presenting for the first time with coronary heart disease, including those with exertional angina who are normally managed in primary care. Lifestyle, risk factor, and therapeutic targets can be successfully achieved in most patients with such a hospital based programme. (Heart 2001;85:533-538)

Efficacy of an intensive prevention program in coronary patients in primary care, a randomised clinical trial

“…Risk-factor-specific [6][7][8][9][10] and comprehensive [11][12][13][14][15] interventions have reduced MI recurrences, mortality, and/or risk factor levels.…”

The involvement of pharmacists in cardiac rehabilitation: a review of the literature

“…7,[9][10][11][12][13][14] Efforts to reduce this variation in service provision and redress the balance to include all patients eligible for CR have resulted in the publication of standards for prevention and treatment of CHD, for example in the UK the National Service Framework for CHD. 15 Typically the literature does not mention medicines when discussing CR, [5][6][7][8][9][10]12,13,16,17 although exceptions include a report of a cardiac liaison nurse who discussed the importance of compliance with medicines with certain patients as part of an alternative customised rehabilitation package, 11 and some papers about CR that make cursory mention of the use of medicines, or comment that patients value medicines information given. [18][19][20][21] While pharmacists are commonly involved in CR programmes, their involvement has been as variable as CR service provision itself.…”

Who needs a lipid clinic?

“…In those warranting intervention, Martin et al. demonstrated that efforts to intensify lipid‐lowering drug therapy and the management of other risk factors may be highly effective in the secondary care setting, as other studies have shown (7,8). This suggests that additional training and education of primary care physicians in lipid management could help them to achieve the goals in more patients.…”

“…Do specialist‐led, hospital‐based clinics and primary care risk factor clinics represent a duplication of effort or do they have a complementary role? A diverse range of secondary care specialists, including cardiologists, diabetologists and chemical pathologists are involved in lipid and risk factor management and, with a few notable exceptions (7), integration of prevention services is lacking, despite the recommendations of recent guidelines (14,15). A holistic assessment of cardiovascular risk, provided locally, is indeed the ideal approach and represents a major strength of the primary care‐based risk factor clinic.…”

“…Further uncertainty may arise if the estimated risk an individual case is unexpected or out of keeping with the lipid status, hyperlipidaemic patients appearing more likely to receive statin treatment than normolipidaemic patients at equivalent risk (6). In those warranting intervention, Martin et al demonstrated that efforts to intensify lipid-lowering drug therapy and the management of other risk factors may be highly effective in the secondary care setting, as other studies have shown (7,8). This suggests that additional training and education of primary care physicians in lipid management could help them to achieve the goals in more patients.…”