Author + information
- Eleanor G. Levin,
- Sonja von Coll and
- Richard Dlott
Background: Kaiser Permanente Northern California (KPNC) is a large HMO with nearly 4 million members of diverse ethnicities and socioeconomic backgrounds in rural, suburban, and urban environments. Since the early 1990s, KPNC has had a home-based cardiac rehab program implemented by nurses with cardiologist supervision. We examined the effectiveness of our program to achieve medication adherence, smoking cessation, increased exercise and improved diet.
Methods: Patients were contacted by phone or email and completed a questionnaire about diet, exercise, smoking, and stress. After a 2-hour group class, they were given a care plan approved by a cardiologist. Nurses contacted patients by email or phone monthly. Twice during the 6-month program, patients completed a questionnaire about their diet, exercise, smoking, and stress. Medication adherence was verified via Rx pickup.
Results: From July 2014 to Feb 2015 there were 3543 patients with cardiac events, and all patients were offered cardiac rehab and 1456 patients enrolled. At the end of 2015, the results of the 6-month program were as follows: 98% not smoking, 47% exercising more than 150 minutes/week, 84% maintaining a low-fat diet (17% plant-based), and more than 92% adherent to the use of beta blockers post myocardial infarction (MI). Most recently (Sept 2016), adherence with beta blockers post MI rose to greater than 95%. Prior to 2014, the LDL measurements were tracked. March 2013 included 496 patients enrolled with results in Sept 2013 of 97% nonsmoking, 85% BP controlled to <= 139/89, and 83% LDL <= 99.
Conclusions: Although guideline-recommended interventions are documented to reduce major adverse cardiovascular events post MI, adherence has been poor nationwide. Nationwide, rates of non-adherence for evidence based therapy are up to 40% of subjects. KPNC has had remarkable success over decades in achieving adherence in our population, with a beta blocker post MI adherence rate in excess of 95%. KPNC's coordinated approach, involving cardiologists collaborating with nurses and using an automated communication system, has resulted in high rates of achieving goals for cardiac rehabilitation in a large, diverse patient population.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Measuring Success in Cardiac Rehabilitation
Abstract Category: 34. Prevention: Rehabilitation
Presentation Number: 1147-040
- 2017 American College of Cardiology Foundation