Abstract
PURPOSE: Previous studies have shown that correct management of different coronary risk factors can reduce coronary event rates. However, significant undertreatment of hyperlipidemia, diabetes, and hypertension is still found during clinical practice. The purpose of this study was to evaluate the effectiveness of an individualized management program to modify coronary disease risk profile.
METHODS: One hundred sixty-eight patients discharged from a cardiac rehabilitation department after acute coronary events were prospectively randomized into 2 management strategies: 84 started usual community care and 84 entered a Coronary Artery RIsk MAnagement Programme (CARIMAP) delivered by the rehabilitation day-hospital. Coronary risk profile, optimized therapy, and management were evaluated after the acute event and again after a followup of 9 +/- 4 months in both groups.
RESULTS: Patients accessed the day-hospital an average of 4 +/- 1 months (range, 1-13 months) after the acute event. The duration of the CARIMAP was 5 +/- 2 months and the individual number of accesses to the day-hospital was 4 +/- 3.8. After the CARIMAP, patients received better-optimized therapy ([beta]-blockers 57% vs 85%, P < .0001; angiotensin-converting enzyme inhibitors 54% vs 84%, P < .00001; statins 38% vs 78%, P < .0001; and amlodipine 22% vs 51%, P < .0001) and had a better risk profile (low-density lipoprotein-cholesterol < 100 mg/dL 30% vs 42%, P < .0001; blood pressure < 140/90 mmHg 63% vs 88%, P < .00001).
CONCLUSION: The CARIMAP of secondary prevention delivered by a rehabilitation day-hospital to patients who had undergone an acute coronary event, enabled individually titrated therapy and better control of coronary artery risk factors.