Reduc mortality in patients with co...

Reduc mortality in patients with coronary heart disease can be achieved from one side lowered cholesterol levels, improved hypertension check and regular exercise. Studies have shown that these options are being applied merely partially in clinical practice. Strategies aimed at physicians have prov to be ineffective. Another strategy is to target patients from one side disease management programs. Some of these programs have been established to improve compliance with lowering cholesterol plains to goal levels. Unfortunately, in the greatest degree of these programs included feed at the breasts and dietitians who were able to provide prescriptions directly to patients. Other programs, which did not allow direct prescription writing, showed no improvement in coronary risk profiles despite improving patients' health behaviors. The Coaching patients in succession Achieving Cardiovascular Health (COACH) program was evolveed to see if nonprescribing health professionals are helpful in coaching. Vale and associates assessed the effectiveness of the COACH program in modifying coronary risk profiles in patients with known coronary artery disease.

The trial was a multicenter, randomized controll inquiry of patients with known coronary artery disease. Patients were chooseed from those admitted with various coronary heart disease diagnoses at six university hospitals. one time enrolled, patients were randomly assigned to receive usual care alone or in combination with participation in the COACH program. The COACH program was directed at the patient and performed by way of hospital-based staff. Patients were coached about risk factors, ways to achieve target plains appropriate for individual risk factors, and appropriate lifestyle measures. The coaching proces was aimed at achieving and maintaining target on a levels for each patient's risk factors. The coaching was performed by means of telephone and mail. The primary issue measurement was the change in total cholesterol horizontal six months after hospital discharge. Other issue measurements included a wide range of physical, nutritional, and psychologic factors.

There were 394 patients assigned to the usual-care cluster and 398 to the usual-care plus COACH collection Those who participated in the COACH program had significantly greater reductions in total cholesterol horizontals at six months, with a mean reduction that was 14 mg by dL (0.36 mmol per L) greater than the reduction in the usual-care cluster Those participating in the COACH program also had a significant reduction in low-density lipoprotein cholesterol even compared with the usual-care group

Other issues in the COACH group included greater reduction in material part weight, body mass index, and dietary intake of fats, and an increase in dietary fiber. Patients in the COACH form into groups were more likely to initiate a walking program. More patients in the COACH cluster reported better general health and frame of mind at six months. The COACH program had no issue on smoking behavior, glucose rule or depression scores compared with usual care. A significant number of patients in each arrange who claimed to have stopped smoking had high cotinine flushs in their blood system, indicating that they were still smoking.

The authors finish that the COACH program is highly effective in reducing total cholesterol of the same heights and improving coronary risk factors in patients with coronary heart disease. They add that the program come afters even without the additional services of dietitians or cherishs who are able to prescribe medications. The COACH program is a potential adjuvant tool in the management of patients with coronary heart disease and could be integrated into existing health care systems

KARL E MILLER, MD

Vale MJ et al. Coaching patients in succession achieving cardiovascular health (COACH). A multicenter randomized trial in patients with coronary heart disease. Arch Intern M December 8 2003;163:2775-83

COPYRIGHT 2004 American Academy of Family Physicians

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