Lack Of Age And Gender Bias In Long-term Outcomes In Case Management-based Cardiovascular Rehabilitation

Abstract

Randomized clinical trials have demonstrated the benefits of case management for patients with coronary heart disease (CHD). It is not known if case management in routine clinical practice, in the setting of an outpatient cardiovascular rehabilitation program (CRP), is feasible and effective in long-term secondary prevention. Purpose To determine the feasibility and clinical benefits of long-term case management of younger and older men and women with CHD in routine clinical practice using CRP staff. Methods Consecutive patients referred to CRP after an acute coronary event in 1999 and 2000 (n = 503, 75% men, age 66±12 yrs) and who were available for 3 years of case management served as subjects. Case managers assessed secondary prevention goals every 3–6 months and adjusted lifestyle factors and medications via face-to-face meetings with each patient. Outcome measures included amount of habitual exercise training, use of cardioprotective medications, coronary risk factors, and all-cause mortality. Results After 3 years of follow-up, secondary prevention variables were as follows: exercise training, minutes/wk (139±123), aspirin use (91%), statin use (91%), beta blocker use post myocardial infarction (78%), angiotensin converting enzyme inhibitor use if ejection fraction less than 40% (76%), LDL cholesterol, mg/dL (90±23), systolic blood pressure, mm Hg (126±19), smoking (9%), BMI (29.0±5.1). Over 3 years there were 29 deaths (annual mortality: 1.9%). There were no differences (p > 0.05) in medication use or risk factor control for men vs women or for age less than 65 yrs vs more than 65 yrs. Conclusions Long-term case management of CHD patients in routine clinical practice by CRP staff is both feasible and generally effective in achieving secondary prevention goals for both men and women irrespective of age. Overweight remains a persistent risk factor.