Abstract P213: Outcomes of a Postdischarge Coronary Artery Disease Management Program

Abstract

Background: The coronary artery disease management (DM) program was designed to improve patient care with the same or lower costs in patients discharged from a university hospital. We tested whether the DM program reduced emergency department (ED) visits, re-hospitalizations, and adverse cardiovascular outcomes. Methods: In this prospective study, we analyzed 141 subjects from the Global Registry of Acute Coronary Events (GRACE). There were 47 subjects that participated in the DM program and 94 subjects participated in GRACE alone with conventional care (CC). DM program subjects received a comprehensive risk assessment, education regarding medication, recognition of significant symptoms, emergency response, review of basic nutrition and exercise and psychosocial support. The primary end point was ED visits at 6 months. Secondary end points were re-hospitalization and incidence of major adverse cardiovascular events (MACE). Disease management subjects were matched 1:2 to controls based on age, gender and GRACE 6 month mortality risk score. Results: At 6 months, a significantly lower number of ED visits were associated with patients in the DM group compared to CC (17 vs 59 visits, p=0.04). There were a total of 6 adverse cardiovascular events (myocardial infarction, n = 4 and death, n = 2), all of which occurred in the conventional care group. There were no significant differences in hospitalization rates resulting from ED visits among the CC and DM groups [76% (45/59) vs 71% (12/17), p=0.75]. Conclusion: The DM program resulted in a significantly reduced number of ED visits, which would translate into lower cost of care. However, the program did not demonstrate a significant effect on the rate of re-hospitalization and MACE.