Clinical investigation
Clinical trial of an educational intervention to achieve recommended cholesterol levels in patients with coronary artery disease

https://doi.org/10.1016/j.ahj.2003.06.003Get rights and content

Abstract

Background

Despite national efforts to improve cholesterol management for patients with coronary artery disease, many patients are not reaching recommended cholesterol target levels. We sought to determine whether a nurse-based educational intervention, designed to educate patients with confirmed coronary artery disease about personal low-density lipoprotein (LDL) cholesterol target levels and encourage partnership with physicians, could increase adherence with National Cholesterol Education Program target levels (LDL cholesterol level ≤100 mg/dL).

Methods

Patients hospitalized with confirmed coronary artery disease were randomized to undergo a nurse-based educational intervention (375 patients) or usual care (381 patients) for a 12-month period after hospitalization. The primary outcome was the proportion of patients at the LDL cholesterol target level 1 year after hospitalization. The secondary outcome was the proportion of patients with accurate knowledge of LDL cholesterol target levels.

Results

The groups were similar at baseline in demographic and clinical characteristics, percent at LDL cholesterol target level (43.9% and 41.1%, respectively), and percent with knowledge of LDL cholesterol target levels (both 5%). The proportion of patients at LDL cholesterol target levels at 1 year did not differ between the intervention (70.2%) and usual care group (67.4%, P = .46). At the conclusion of the trial, patient knowledge about LDL cholesterol target level was higher for the intervention group than the usual care group (19.6% and 6.7%, respectively, P = .001), but this was not associated with improved cholesterol management.

Conclusions

Our nurse-based educational intervention did not result in a significant increase in the proportion of patients who reached target LDL cholesterol levels 1 year after hospitalization. Although the intervention improved patient knowledge of LDL cholesterol target levels, overall rates of LDL cholesterol knowledge remained low, and it was not associated with improved cholesterol management.

Section snippets

Study participants

Consecutive medical patients admitted to Yale-New Haven Hospital between December 1998 and January 2000 were screened for evidence of documented coronary artery disease, defined as a current or past diagnosis for an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or coronary artery stenosis ≥70% documented by means of cardiac catheterization. Patients were excluded because of: age ≤30 years or ≥80 years, out-of-state

REACH trial enrollment

A total of 2657 patients with coronary artery disease were screened for participation in the trial (Figure 1). Fifty-five percent of screened patients (1649) did not meet ≥1 inclusion criteria (age, 351 patients; out-of-state residency, 301 patients; terminal illness, 90 patients; contraindications to cholesterol-lowering medication, 49 patients; residency in long-term care facility, 22 patients; unable to communicate, 280 patients; drug or alcohol abuse, 157 patients; severe comorbidity, 210

Discussion

Our nurse-based educational intervention did not improve compliance with recommended LDL cholesterol level guidelines among patients with coronary artery disease. In addition, our study did not identify an increased advantage for patients who were more knowledgeable about cholesterol. The findings raise concerns about a focused patient education approach to improving lipid levels.

Our intervention was consistent with the work by Wagner et al, which identified that a key to successful chronic

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    Supported by a grant from Pfizer. Dr Lichtman is a Goddess Fund Career Development Scholar.

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