Key result
A dedicated post-ACS clinic run by a physician extender did not significantly improve the achievement of LDL cholesterol <100 mg/dL at 3 months compared to usual care (57% vs 69%, P=0.43).
Why the study?
Does the addition of a physician extender visit using a disease management algorithm improve achievement of low-density lipoprotein treatment goals at 3 months in patients admitted for acute coronary syndromes?
RCT (n=140)
No
Does the addition of a physician extender visit using a disease management algorithm improve achievement of low-density lipoprotein treatment goals at 3 months in patients admitted for acute coronary syndromes?
Absolute Event Rate: 57% vs 69%
p-value: p=0.43
The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not improve adherence to evidence-based secondary prevention treatment goals at 3 months.
Does not support physician extender-led post-ACS clinics for LDL goal achievement; challenges efficacy of disease management algorithms in secondary prevention.
BACKGROUND: The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected populations. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes (ACSs) in a largely indigent county hospital setting. METHODS: Patients admitted for ACS were randomized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit. Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines. Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence-based practice goals. RESULTS: One hundred forty consecutive patients were randomized. A similar proportion of patients returned for study follow-up in both groups at 3 months (54 [79%]/68 in the usual care group vs 57 [79%]/72 in the intervention group; P = 0.97). Among those completing the 3-month visit, a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 (69%) of the usual care patients compared with 35 (57%) of those in the intervention group (P = 0.43). There was no statistical difference in implementation of therapeutic lifestyle changes (smoking cessation, cardiac rehabilitation, or exercise) between groups. Prescription rates of evidence-based therapeutics at 3 months were similar in both groups. CONCLUSION: The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence-based secondary prevention treatment goals. Despite initially high rates of evidence-based treatment at discharge, adherence with follow-up appointments and sustained implementation of evidence-based therapies remains a significant challenge in this high-risk cohort.
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Yorio et al. (2008) conducted an RCT in Acute coronary syndromes (n=140). Physician extender visit with disease management algorithm vs. Usual follow-up care was evaluated on Achievement of low-density lipoprotein treatment goals (<100 mg/dL) at 3 months after discharge (p=0.43). A dedicated post-ACS clinic run by a physician extender did not significantly improve the achievement of LDL cholesterol <100 mg/dL at 3 months compared to usual care (57% vs 69%, P=0.43).
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