Key result
An interventional self-management program for patients with acute coronary syndrome increased the proportion of patients achieving LDL <70 mg/dL from 12.4% to 23.7%.
Why the study?
ACS recurrence rates are increasing due to incomplete risk factor control, and most patients are first-time sufferers requiring disease care self-management and continuous professional support.
Does a self-management program improve risk factor control and readmission rates in patients with acute coronary syndrome?
Does a self-management program improve risk factor control and readmission rates in patients with acute coronary syndrome?
Absolute Event Rate: 23.7% vs 12.4%
An individualized self-management program led by a case manager significantly improved LDL control and was associated with low readmission rates in patients with acute coronary syndrome.
Supports self-management programs for ACS risk control; leaves open confirmation of readmission benefits in RCTs.
Background: The mortality rate of acute coronary syndrome (ACS) has significantly improved, but the recurrence rate has been increasing year by year, mainly due to the incomplete control of risk factors. According to clinical statistics, 80% of ACS patients are first-time sufferers and require self-management program for disease care and continuous support from professionals. Objectives: This study aimed to investigate the effect of self-management and readmission in patients with ACS with an intervention management program. Methods: This quasi-experimental study used purposive sampling. The study was performed from January 20, 2020 to December 31, 2021, and involved 97 cases. A case manager was used in the self-management program, using “the Chinese version of the Seattle Angina Questionnaire (SAQ)” and the self-made “acute coronary syndrome self-management questionnaire (ACS-SMQ)” before and after hospitalization and the post-hospitalization blood tests and medical records for each participant. Results: ACS-SMQ ( F = 324.524, P < 0.001), low-density lipoprotein (LDL) levels ( F = 34.428, P < 0.001), and hemoglobin A1c levels ( F = 3.154, P = 0.048) were evaluated before and after the intervention program. The number of patients with LDL of <70 mg/dL increased from 12.4% to 23.7%, and participants with LDL levels of <100 mg/dL increased from 36.1% to 56.7% before and after the intervention, respectively. The readmission rate was 4.1% (4/97), 11.3% (11/97), and 3.1% (3/93) at 1, 6, and 12 months, respectively. The LDL level during hospitalization was negatively correlated with 1- ( r = -0.236*, P < 0.05), 6- ( r = −0.220*, P < 0.05), and 12-month readmission rates ( r = −0.212*, P < 0.05) (* When P = 0.05 (two-tailed), the correlation was significant). Conclusion: The readmission of patients with ACS is associated with LDL levels during hospitalization. Therefore, an individualized intervention management program should be used to adjust the lifestyle of patients during hospitalization to control risk factors. If high-intensity statin therapy is used strictly according to the guidelines, patients may receive higher doses than they require if the guidelines are to be strictly followed, which will easily affect their medication compliance. The case manager is a clinical application that needs to be carefully considered.
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Yang et al. (2023) studied Acute coronary syndrome (n=97). Self-management program with a case manager vs. Pre-intervention baseline was evaluated on Proportion of patients with LDL <70 mg/dL. An interventional self-management program for patients with acute coronary syndrome increased the proportion of patients achieving LDL <70 mg/dL from 12.4% to 23.7%.
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