 n the past decade, a wealth of
data from both clinical trial and interventional studies
has proven that clinicians who treat patients with
coronary heart disease (CHD) can reduce the future risk
of recurrent CHD events, reduce mortality, and improve
quality of life. These treatments include the acute
management of myocardial infarction and unstable angina
with thrombolytics, primary angioplasty, and
antithrombotic agents, as well as long-term treatment
with beta-blockers, aspirin, angiotensin-converting
enzyme inhibitors, and statins. Major changes in
lifestyle behavior have also shown benefit, such as
smoking cessation, low-fat diets, weight reduction, and
regular exercise. While
most clinicians readily acknowledge the effectiveness of
these treatments in the post-acute coronary syndrome
(ACS) hospital setting, they are often frustrated by
their patients' lack of adherence to these lifesaving
therapies. The reasons for this reduced adherence and
persistence to recommended lifestyle changes and drug
treatments are many and complex. Most of the frequently
cited reasons involve shortcomings of the health care
delivery system and are potentially correctable. Some of
these are lack of time to fully educate patients in the
hospital setting prior to discharge, inadequate numbers
of or proximity to cardiac rehabilitation programs for
aftercare participation, inadequate insurance coverage
for these programs, limited time and low reimbursement
for private physician office education, and limited
insurance coverage for prescription medications. These
barriers may be overwhelming and can only be overcome by
a coordinated effort from managed care organizations or
large integrated health care providers. The article in
this issue of Baylor University Medical Center
Proceedings demonstrates how such a coordinated
multidisciplinary approach can provide a vehicle to help
patients adhere to post-ACS lifestyle and medication
programs.
The Leap for Life program
of the Baylor Health Care System was born out of
frustration with the lack of educational opportunities
for CHD patients who had no access to traditional phase
II cardiac rehabilitation programs. The program's
subsequent success allowed it to expand its mission to
include all patients discharged from the system's
hospitals following a myocardial infarction or cardiac
catheterization. The authors describe their experience
with 152 participants over a 12-month period, focusing on
patient perceptions of goal achievement, satisfaction,
and hospital readmission. Three quarters of the
participants felt that the program helped them meet all
or some of their goals, and 100% of them thought the
workshops met their educational needs.
The participants' success
rate for achieving their own preset goals is satisfying,
particularly for smoking cessation and control of blood
pressure and diabetes. On the other hand, the program
shows us how difficult some lifestyle changes can be,
specifically reducing weight and stress. Although not
described, it would be important to measure medication
adherence and persistence and quality of life.
Ultimately, determining the impact that goal achievement
has on recurrent CHD events and hospital admissions would
allow an analysis of the cost-effectiveness of the Leap
for Life program. The Baylor Health Care System has
initiated an important educational program for the
post-ACS patient. Its initial success should be applauded
and should encourage other managed or integrated health
care groups to follow suit. Expanding the outcomes
measures of the Leap for Life program will most likely
prove that these educational initiatives are not only
cost saving, but life saving as well.
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