Introduction: Cardiac rehabilitation (CR) plays a key role in risk reduction. When medication adjustment is necessary to attain goals, effective communication with the primary care physician (PCP) can be challenging.
Purpose: To compare the effectiveness of two interventions, directed towards the PCP, to improve the number of patients achieving low density lipoprotein cholesterol (LDL-C) goal in CR.
Design: This investigation was a retrospective observational cohort design.
Methods: This analysis involved CR participants between 11/1/06 and 12/31/07. Participants included in analysis had an entry LDL = 100, a CAD related diagnosis, and complete entry/exit lipid profiles. Following CR enrollment, each participant's cardiologist and PCP received a letter from the CR Medical Director detailing lipid goals and therapeutic options. All individuals participated in the same CR program. Two different interventions were delivered over two distinct time periods. For participants entering CR between 11/1/06 and 4/30/07 the lipid intervention consisted of monthly faxes sent to the PCP on progress toward lipid goals. This group was defined as the fax group (n = 40). For participants entering CR between 5/1/07 and 12/31/07, the lipid intervention consisted of a phone call from the CR staff to the PCP's nurse to discuss the CR medical director's recommended lipid medication changes and for permission to implement the changes. If permission was received, sample medications and a prescription were given to the patient. The patient was scheduled for a lipid profile and LFTs in 6 weeks to assess efficacy and tolerance of the change. This group was defined as the direct intervention group (n = 29). Frequency data was compared using chi square analysis. Means were compared using unpaired t tests.
Results: There were no significant differences between groups in demographics, comorbidities, or entry clinical characteristics. Upon CR completion, there was no difference in the improvements in weight, HDL, and triglycerides. However, the direct intervention group had a statistically significantly greater decrease in cholesterol, LDL, and non HDL-C compared to the fax intervention group. The direct intervention group was also significantly more likely to reach LDL goal compared to the fax group (86% vs 62.5%, P = .03, respectively).
Conclusions: Use of systematic reminders directed at the PCP during CR can substantially increase the percentage of patients achieving ATP-III LDL-C goals. However, direct verbal contact with specific recommendations from the medical Director is most effective.