Rationale and design of the cardiac hospitalization atherosclerosis management program at the University of California Los Angeles

Despite clear and consistent clinical-trial evidence that secondary-prevent ion medical therapies reduce mortality in patients with established coronar y artery disease, these therapies are underutilized in patients receiving c onventional care. To address this issue, a Cardiac Hospitalization Atherosc lerosis Management program (CHAMP) focused on initiation of aspirin, choles terol-lowering medication (3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitor titrated to achieve low-density lipoprotein [LDL] chole sterol <100 mg/dL), beta-blocker, and angiotensin-converting enzyme (ACE)-i nhibitor therapy in conjunction with diet and exercise counseling before ho spital discharge in patients with established coronary artery disease was d esigned and implemented at the University of California Los Angeles (UCLA) Medical Center starting in 1994, This treatment program was based on the hy pothesis that initiation of therapy in the hospital setting would result in higher utilization rates both at the time of discharge and during longer-t erm follow-up. Implementation of this program involved the use of a focused treatment guideline, standardized admission orders, educational lectures b y local thought leaders, and tracking/reporting of treatment rates. To asse ss the impact of the program, treatment rates and clinical outcome were com pared in patients discharged in the Ii-year periods before and after CHAMP was implemented. Hospital-based treatment protocols such as CHAMP have the potential to significantly increase treatment utilization of therapies prev iously demonstrated to improve survival and thus substantially improve the outcome of the 2 million patients diagnosed and hospitalized each year with coronary artery disease. (C) 2000 by Excerpta Medico, Inc.