A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery disease patients: The heartcare I trial

BACKGROUND: Case-management programs for secondary prevention of coronary a rtery disease that utilize extensive resources can reduce cardiovascular ri sk factors, but less intensive approaches have failed to show benefits. Thi s randomized trial evaluated whether a medium intensity case-management pro gram improves risk factor control in patients with coronary artery disease. METHODS: We assigned 201 consecutive patients hospitalized for acute corona ry events in the intensive care unit of University Hospital, Basel, Switzer land, to either a risk factor case-management program (n = 99) ol care as u sual (n = 102) using the patients' primary care physicians as the unit of r andomization (cluster randomization). The case-management program consisted of an hour of counseling by a clinician during hospitalization and two sho rt reminders by phone and mail 3 and 6 months later. Treatment decisions we re left to patients and their primary care physicians. RESULTS: After 9 and 18 months of follow-up, there were no significant diff erences in lipid values, blood pressure control, fasting blood glucose, bod y-mass index, or number of smokers between the two groups. However, signifi cantly more patients in the intervention group than in the care as usual gr oup achieved target cholesterol values after 18 months (48% versus 27%, P = 0.002 and remained significant after Bonferroni-Holms correction) but not after 9 months of follow-up (31% versus 27%, P >0.2). CONCLUSION: This hospital-based case-management and outreach program, limit ed to counseling by a clinician, did not substantially improve cardiovascul ar risk factor control among patients hospitalized for coronary events. (C) 2001 by Excerpta Medica, Inc.