Clinical investigationClinical trial of an educational intervention to achieve recommended cholesterol levels in patients with coronary artery disease☆
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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Cited by (26)
The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study
2014, International Journal of Nursing StudiesCitation Excerpt :Two other comparable nurse-led secondary prevention studies have reported recruitment rates in the 70% range (Campbell et al., 1998; Goessens et al., 2006). Attrition rates of 10–18% (Goessens et al., 2006; Lichtman et al., 2004; Masley et al., 2001; Vesthold Heartcare Study Group, 2003) are common in secondary prevention studies, with few reporting less than 10% (Lear et al., 2003; Redfern et al., 2009). The low attrition rate observed in this study could be related to the short follow-up period.
Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases
2012, Patient Education and CounselingCitation Excerpt :CAD also exacts a tremendous economic toll, resulting in expenditures of almost $152 billion in the United States in 2007 [2]. Studies have shown that educational interventions can improve patients’ knowledge of CAD risk factors [3,4] and also improve health behaviors [5,6] and clinical outcomes [7]. The World Health Organization has strongly endorsed the concept of therapeutic patient education as a strategy to improve patients’ active participation in the process of disease management [8].
Non-physician health care providers for the treatment and care of the chronically III (focusing on DMP diagnoses)
2009, Zeitschrift fur Evidenz, Fortbildung und Qualitat im GesundheitswesenEfficacy over time of a short overall atherosclerosis management programme on the reduction of cardiovascular risk in patients after an acute coronary syndrome
2009, Archives of Cardiovascular DiseasesEmergency Department education improves patient knowledge of coronary artery disease risk factors but not the accuracy of their own risk perception
2007, Preventive MedicineCitation Excerpt :As there was no retention of knowledge at 30 days in either group, it is interesting that these patients at 30-day follow-up were still grossly overestimating their likelihood of having a heart attack within the next 10 years. Lichtman et al. similarly found that a nurse-based educational intervention did not result in a significant increase in the proportion of their patients who reached a target LDL cholesterol level 1 year after hospitalization, although their intervention improved patient knowledge of LDL cholesterol target levels (Lichtman et al., 2004). It is interesting to note that in our study patients overestimated their likelihood of having a heart attack within the next 10 years and had indeed just visited the Emergency Department for chest pain of a potentially cardiac nature, yet had not improved their knowledge of their own risk factors or their perception of their own risk in the 1 month after their visit.
Population survey of diabetes knowledge and protective behaviours
2006, Canadian Journal of Diabetes
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Supported by a grant from Pfizer. Dr Lichtman is a Goddess Fund Career Development Scholar.