Why heart attack patients should take on a 'COACH'
A Melbourne study has recommended heart surgery patients should take on a 'coach' after they leave hospital to help them reduce heart disease risk-factors and the chance of further hospitalisation.
The study monitored risk-factors in two groups of coronary heart disease patients after they had been discharged from hospital after interventions for heart disease. The first group comprised 112 patients (1996 to 1998) and the second group 348 patients (1999 to 2000), all of whom agreed to join a contolled trial of risk-factor intervention the COACH Study. These patients were in the control group of two clinical trials of coaching - they had usual medical care.
Modifiable risk-factors for coronary heart disease include cholesterol levels, smoking, blood pressure, saturated fat intake, alcohol and exercise.
The comparitive study found that the second and more recent group of patients had achieved a marked improvement in reaching national risk-factor targets, particularly lower cholesterol levels.
Study co-author, Margarite Vale, from the Department of Cardiology and the University of Melbourne's Department of Medicine at St Vincent's Hospital in Melbourne, said that this result was largely due to an increase in the number of patients prescribed lipid-lowering drugs after leaving hospital.
Ms Vale said another reason for the result may have been that the second group of patients was discharged with a chart of risk-factor targets, which was given to each patient's usual medical carer.
'Providing this chart was not usual practice and may have had an enhancing effect on usual care," she said.
"Although the current treatment gap in Victoria for lipid targets compares well with published international data, the gaps are not acceptable and will undoubtedly result in an excess number of cardiovascular deaths, infarcts and patients needing revascularisation.
"Large treatment gaps exist for risk-factors such as high blood pressure, diabetes, overweight and obesity, smoking, physical activity, dietary intake of saturated fat and alcohol intake."
Dr Vale said a proven way of helping patients with coronary heart disease achieve their risk-factor targets was the "aggressive training program" known as the Coach Program.
"A health professional coach trains patients to take ownership of their risk-factor levels, while working in association with their doctors," Ms Vale said.
"The program has been tested, and the results have shown that coaching has had a major impact on these risk-factors and may be the bridge across the treatment gap," she said.
The Medical Journal of Australia is a publication of the Australian Medical Association.