Effectiveness of a planned strategy using cardiac rehabilitation nurses for the management of dyslipidemia in patients with coronary artery disease

Background Firm evidence exists for reduction in mortality and morbidity by lipid-lowering therapy in patients with coronary artery disease (CAD), yet a significant proportion remain untreated. This prospective study determin ed the effectiveness of a planned strategy of management using a cardiac re habilitation nurse in achieving (1) lower 6-month low-density lipoprotein ( LDL) levels and (2) a higher proportion of patients on pharmacologic therap y. Methods A cardiac rehabilitation nurse arranged for the lipid profiles and initiated pharmacologic therapy as soon as possible after the diagnosis of CAD. In phase 1, this planned-strategy intervention group (n = 80) was comp ared with the usual-care control group (n = 189), where the management was left at the discretion of the attending cardiologist with the assignment to the 2 groups based on the weekly on-call rotations of the attending cardio logists in a nonrandomized manner. In phase 2 of the study all patients (n = 366) were enrolled in the planned strategy of management. Results There were no significant differences in the baseline lipid values between the control and intervention groups. The 6-month cholesterol and LD L values and the percentage of patients on lipid-lowering medications were significantly better in the intervention group (P = .01). In phase 2 the re sults obtained in the intervention group were duplicated in a much larger g roup of consecutive patients. The 6-month (millimoles per liter) results in the control, intervention, and phase 2 groups (respectively) were choleste rol 4.92 +/- 0.06, 4.60 +/- 0.07, 4.30 +/- 0.05; low-density lipoprotein 2. 91 +/- 0.06, 2.68 +/- 0.07, 2.4 +/- 0.06; high-density lipoprotein 1.18 +/- 0.07, 1.12 +/- 0.09, 1.10 +/- 0.01; triglycerides 1.89 +/- 0.12, 1.78 +/- 0.09, 1.70 0.05; and on medications 49%, 83%, and 84%. Conclusion A planned strategy of management with use of early pharmacologic therapy with a cardiac rehabilitation nurse assigned to obtain and follow lipid profiles and initiate therapy is more effective in controlling dyslip idemia than leaving the management to the cardiologist.