A Systematic Approach to Improve Lipids in Coronary Artery Disease Patients Participating in a Cardiac Rehabilitation Program

In Brief PURPOSE: To determine the effectiveness of an intervention, directed toward the primary care physician (PCP), to improve the number of patients treated to low-density lipoprotein cholesterol (LDL-C) goal in a cardiac rehabilitation (CR) population. METHODS: A pre-post intervention cohort comparison using data collected from participants in a CR program with LDL-C ≥100 mg/dL at entry. The control cohort participated in CR between 1/00 and 10/02, 41.5% (n = 178) had an entry LDL-C ≥100 mg/dL. The intervention cohort participated in CR between 10/03 and 1/05, 26.4% (n = 67) had an entry LDL-C ≥100 mg/dL. The intervention group had identical treatment as the control group as well as the following: each participant with an LDL-C ≥100 mg/dL in the intervention cohort had an entry letter sent to his or her cardiologist and PCP from the programs Cardiology Medical Director, detailing the lipid goals and therapeutic options. In addition, monthly faxes on progress toward lipid goals were sent to the PCP. RESULTS: The control cohort was less likely to achieve LDL-C goal compared with the intervention cohort (43% vs 67%, respectively; P = .001). A patient was also less likely to have a lipid medication change during CR in the control group compared with the intervention group (29% vs 42%, respectively; P = .05). CONCLUSION: Use of systematic reminders directed at the PCP during CR can substantially increase the percentage of patients achieving nationally recognized LDL-C goals. This study was done to determine the effectiveness of an intervention, directed toward primary care physicians, to improve the number of patients treated to LDL-C goal in cardiac rehabilitation. A physician-directed intervention was associated with a 55.8% relative increase in the percentage of participants achieving LDL-C goal on exit.