People recovering from acute heart problems such as heart attack and heart surgery are more likely to develop habits to control heart attack risk factors when they meet regularly with cardiac "disease managers," according to researchers at Mayo Clinic in Rochester. These managers are nonphysician cardiac rehabilitation specialists who lead long-term follow-up programs that last three years. With these risk factors under control, heart patients are likely to live longer and have fewer heart problems.

The researchers studied the effects of a long-term cardiac disease manager model on 503 patients involved in cardiac rehabilitation. The disease manager's role was to monitor the patient's status, and to coach the patients in adopting heart attack prevention behaviors. At each meeting, the following factors were assessed and management strategies were discussed: blood lipid levels, blood pressure and body weight, tobacco use, cardiac medication compliance, exercise regimen and physical activity, nutrition and cardiopulmonary symptoms. After initial rehabilitation training about risk factor management, each patient met with a trained disease manager every three to six months for three years

• It is feasible to provide long-term disease management to heart patients in an outpatient setting. Mayo's model calls for trained cardiac rehabilitation specialists to function as disease managers who maintain a relationship with the patients and meet face-to-face every three to six months. This follows an initial intensive training period about lifestyle changes and medications. In contrast, aftercare programs often are only a few months long and lack coordination and direct involvement of health care providers who are specifically trained in cardiac rehabilitation, or who rigorously review clinical and lifestyle data.
• The approach offers clear clinical benefits. At three years, the participants attained and maintained most of the behaviors for preventing subsequent heart attacks. These behaviors are known as secondary heart-attack prevention measures. They include exercising regularly and taking specific heart-protecting medications. Most lowered their cholesterol levels and blood pressure to within recommended levels. Of the 503 participants, compliance with aspirin usage was 91 percent; statin usage, 91 percent; beta-blocker usage, 78 percent; and angiotensin-converting enzyme inhibitor usage, 76 percent.
• Patients in the disease manager model of care versus traditional care had a lower death rate. While larger studies will need to validate this finding, over the three years of the study, 29 participants died, (25 men and four women), an annual death rate of 1.9 percent. This compares to the Centers for Disease Control and Prevention's expected annual death rate of 1.6 percent for Americans of comparable ages in the general population without heart problems. By comparison, the annual death rate over three years for an additional group of 102 patients who were enrolled in cardiac rehabilitation but who did not receive long-term disease management, was 6.5 percent.
• Being overweight remains a prevalent and persistent risk factor for heart attack. As measured by body mass index, being overweight was the one heart disease risk factor that did not respond well to this disease manager approach. Other studies also have shown body weight to be the most change-resistant variable in efforts to promote heart health.

The findings are important because heart disease is the number one cause of death and disability in the U.S - and though many people survive due to advances in medical care, many patients and physicians don't realize the importance of cardiac rehabilitation in extending survival benefits. Mayo researchers developed the disease manager model of cardiac rehabilitation to extend the lifesaving benefits modern medicine offers, and spare patients the trauma and the expense of repeat surgeries and hospitalizations.

Source: Heart Patients Fare Better In 3-year Program ScienceDaily (June 4, 2008)