Influence of optimised long-term management on the efficacy of cardiological rehabilitation. PROTECT - a prospective controled study.

Background and objective: Long-term risk factor (RF) modification after car diac rehabilitation (CR) is less than satisfactory. Problems of communicati on between the CR centre and the practising physician (GP) are one potentia l source of sub-optimal management. The goal of the PROTECT-study was to ev aluate the influence of improved communication between rehabilitation centr es and the GP on the quality of RF-modification. Patients and methods: In 50 specialized CR centres 882 patients in the grou p with intensified communication were com; pared to 160 patients in the usu al care group. All patients underwent a course of residential CR. Intensifi ed communication was attempted by a total of four phone calls to the GP, a RF booklet in which the RF profile, the individual RF treatment goals and t he current RF status were delineated. Main treatment goals with respect to RF-modification after 6 months were: Blood pressure <140/90 mmHg, LDL-Chole sterol <100 mg/dl or at least 115 mg/dl and a body mass index of <25 or at least <30. Results: The percentage of of patients with adequate blood pressure control (<740/90 mmHg) was 85.1% vs. 85%, with LDL-cholesterol <100 mg/dl 27.2% vs . 23.9%, with good body-mass index (<25) 32.4% vs. 28.2% ( intensified comm unication vs. control group: p = ns). The treatment initiated by the CR cen tres was continued in about 90% of patients. Conclusion: The study has shown that improved communication between the CR centres and the GP's after CR had only a marginal effect on the quality of RF-management. One key element of secondary prevention could be to get the patient more strongly involved in reaching the targets of therapy.