Self-Rated Health Among Patients with Coronary Artery Disease Enrolled in a Cardiovascular Risk Reduction Service.

Little is known about the use of the single self-rated health (SRH) status item measuring health-related quality of life among people with coronary artery disease (CAD). The objective of this study was to assess relationships between SRH and recurrent coronary events, mortality, health care utilization, and intermediate clinical outcomes and to assess predictors of fair/poor SRH. A total of 5573 patients enrolled in a comprehensive cardiac risk reduction service managed by clinical pharmacy specialists were evaluated over a 2-year period.

Positive predictive values of ICD-9 codes to identify patients with stroke or TIA.

Objectives: To determine the positive predictive values of inpatient and outpatient ICD-9 codes and status code V12.54 for identifying confirmed history of stroke or transient ischemic attack (cerebral event) among patients within a managed care organization.

Study Design: Retrospective, cohort study.

Ambulatory treatment gaps in patients with ischemic stroke or transient ischemic attack.

Background: This study evaluated goal attainment for patients with a history of non-cardioembolic ischemic stroke (NCIS) or transient ischemic attack (TIA).

Methods: A cross-sectional study was conducted in patients aged 18 to 85 years with a history of validated NCIS or TIA. Data collected were demographics, comorbidities, blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) values, and medications within 365 days and most proximal to December 31, 2010.

Attainment of low-density lipoprotein cholesterol goals in coronary artery disease.

Background: The National Cholesterol Education Program Guidelines offer an optional low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dL for very high-risk patients with coronary artery disease (CAD). This study evaluated the extent to which this recommendation can be attained by the use of currently available lipid-lowering therapies.

Methods: A retrospective, cross-sectional study of patients in the Kaiser Permanente Colorado healthcare system 18 years of age or older with CAD and a predetermined LDL-C goal less than 70 mg/dL.

Reduced health care expenditures after enrollment in a collaborative cardiac care service.

Study Objective: To assess the impact of a collaborative cardiovascular risk reduction service (Collaborative Cardiac Care Service [CCCS]) on total health care expenditures after an incident acute coronary event.

Design: Matched, retrospective cohort study.

Data Source: Kaiser Permanente Colorado (KPCO) databases.

The risk for significant creatine kinase elevation with statins.

Background: The HMG-CoA reductase inhibitors (statins) are effective for reducing long-term cardiovascular morbidity and mortality in both primary and secondary prevention. The most serious adverse reaction is significant elevation of creatine kinase (CK) leading to rhabdomyolysis. The incidence of CK elevation is low in randomized, controlled trials.

Outcomes of patients discharged from pharmacy-managed cardiovascular disease management.

Objective: To evaluate whether patients with coronary artery disease (CAD) discharged from the Clinical Pharmacy Cardiac Risk Service (CPCRS) would maintain their lipid goals with use of an electronic laboratory reminder system.

Study Design: A 2-year, randomized study at Kaiser Permanente Colorado.

Methods: Patients with prior CAD (acute myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention) who had been enrolled in the CPCRS for at least 1 year and who had 2 consecutive low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol, and blood pressure readings at goal within 6 months before enrollment were randomized to remain in the CPCRS (CPCRS care) or to receive usual care from primary care physicians plus laboratory reminder letters (usual care).

Factors associated with recurrent coronary events among patients with cardiovascular disease.

Study Objective: To determine which factors are associated with recurrent coronary events.

Design: Matched, case-control study.

Data Source: Electronic databases of a health maintenance organization.

Painful diabetic peripheral neuropathy in a managed care setting: patient identification, prevalence estimates, and pharmacy utilization patterns.

The objectives of this study were to validate an algorithm for identifying patients with painful diabetic peripheral neuropathy (pDPN) and demonstrate its practical applications. Using the Kaiser Permanente Colorado Diabetes Registry, an algorithm was developed with selected ICD-9 diagnosis codes combined with automated pharmacy data for medications prescribed for pDPN symptoms. Medical records were reviewed to confirm pDPN presence and to inform algorithm refinement.

Collaborative cardiac care service: a multidisciplinary approach to caring for patients with coronary artery disease.

Background: Coronary artery disease (CAD) remains the leading cause of death in the US. In 1996, Kaiser Permanente of Colorado (KPCO) developed the Collaborative Cardiac Care Service (CCCS) with the goal of improving the health of patients with CAD.

Description: CCCS consists of a nursing team (the KP Cardiac Rehabilitation program) and a pharmacy team (the Clinical Pharmacy Cardiac Risk Service).

Angiotensin-converting enzyme inhibitor therapy for coronary artery disease and diabetes mellitus.

Objectives: To use a population management strategy to increase the proportion of patients with coronary artery disease (CAD) and diabetes receiving target-dose angiotensin-converting enzyme (ACE) inhibitor therapy and to assess the safety and tolerability of this initiative.

Study Design: Prospective cohort.

Methods: Patients were eligible for enrollment if they were not receiving target-dose ACE inhibitor therapy.

Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease.

Study Objective: To determine the effect of early and sustained enrollment in a comprehensive cardiac care (CCC) program on all-cause mortality in patients with coronary artery disease (CAD).

Design: Retrospective, longitudinal cohort study.

Data Source: Kaiser Permanente Colorado tracking database.

The triglyceride-lowering effects of a modest dose of docosahexaenoic acid alone versus in combination with low dose eicosapentaenoic acid in patients with coronary artery disease and elevated triglycerides.

Background: Hypertriglyceridemia is a risk factor for coronary artery disease (CAD). The American Heart Association recommends 1000 mg of omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), daily for cardioprotection and higher doses for triglyceride-lowering in patients with CAD.

Methods: This was a prospective, randomized, double-blind study comparing DHA to DHA + EPA in patients with CAD and triglycerides greater than 200 mg/dL.

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

Purpose: A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described.

Summary: Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes.

Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes.

Objective: There is a need for practical, efficient and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviours such as healthy eating and weight loss. The objective of this study was to evaluate such a computer-assisted intervention.

Methods: Type 2 diabetes primary care patients (n=335) from fee-for-service and health maintenance organization settings were randomized to social cognitive theory-based tailored self-management (TSM) or computer-aided enhanced usual care (UC).

Coronary artery disease and hypertension: outcomes of a pharmacist-managed blood pressure program.

Study Objective: To assess the effectiveness of a pharmacist-managed service in improving hypertension control among patients with coronary artery disease.

Design: Prospective cohort study. Setting.

Effect of a clinical pharmacy service on lipid control in patients with peripheral arterial disease.

Objective: Our group and others have previously established that patients with peripheral artery disease (PAD) are significantly undertreated with respect to overall cardiovascular risk factor management, despite national guidelines to the contrary. In an effort to maximize risk factor control in our patients with PAD, we established a pharmacist-managed, physician-monitored algorithmic approach to the outpatient management of lipids in patients with PAD. The purpose of this study was to determine the effect of this service on lipid screening and control in patients with PAD.

Cost-effectiveness of sibutramine in the LOSE Weight Study: evaluating the role of pharmacologic weight-loss therapy within a weight management program.

Unlabelled: the cost-effectiveness of drug therapy when used in conjunction with a weight management program (WMP) for treatment of obesity. The objective was to compare the cost-effectiveness of sibutramine (Meridia) plus a structured WMP versus only a structured WMP in both overweight and obese individuals. The core WMP was a physician-supervised, multidisciplinary program for which each enrollee paid $100 out of pocket.

Evaluation of cases of severe statin-related transaminitis within a large health maintenance organization.

Purpose: To describe the rate, potential causes, symptoms, time to onset, and time to resolution of severe transaminitis associated with increased 3-hydroxy-3-methylglutaryl coenzyme reductase inhibitor ("statin") usage in a large group model health maintenance organization.

Subjects And Methods: Health plan members 18 years of age and older, not receiving chemotherapy, who had received at least 1 statin prescription between January 1, 1997, and December 31, 2001 were eligible. All eligible patients with an alanine aminotransferase greater than 10 times the upper limit of normal at any time during the study period were identified using computerized laboratory records.

Atherosclerotic risk factor control in patients with peripheral arterial disease.

Background: The presence of peripheral arterial disease (PAD), even in the absence of overt coronary artery disease (CAD), confers the same relative risk of death from a cardiovascular cause as in patients with a previous cardiovascular event. Current guidelines recommend atherosclerotic risk factor-reduction strategies in PAD patients identical to those in patients with a recent coronary event. The purpose of this study was to determine the status of atherosclerotic risk factor control in patients with PAD.

Low myopathy rates associated with statins as monotherapy or combination therapy with interacting drugs in a group model health maintenance organization.

Study Objective: Because the risk for myopathy increases when 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) are used with other agents known to inhibit cytochrome P450 3A4 in patients with dyslipidemia, we sought to quantify this risk in a diverse, real-world sample of patients receiving statin therapy.

Design: Retrospective chart review.

Setting: Kaiser Permanente Colorado (KPCO), a group model health maintenance organization with approximately 360,000 members.

Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization.

Background: Published data indicate that there is a significant treatment gap between the evidence for and the implementation of lipid-lowering therapy and that recidivism is as high as 60% at 1 year. The aim of this study is to examine the impact of a clinical pharmacy cardiac risk service (CPCRS) on lipid screening, control, and treatment outcomes.

Methods: A computer-generated list of all patients with documented coronary artery disease, enrolled in a CPCRS between March 1, 1998, and October 1, 2002, and followed up for a minimum of 6 months was obtained.

Attendance and graduation patterns in a group-model health maintenance organization alternative cardiac rehabilitation program.

Purpose: Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program and the predictors of attendance and graduation.

The Long-term Outcomes of Sibutramine Effectiveness on Weight (LOSE Weight) study: evaluating the role of drug therapy within a weight management program in a group-model health maintenance organization.

Objective: To assess the benefit of sibutramine hydrochloride monohydrate within a weight management program.

Study Design: Prospective randomized controlled trial in a health maintenance organization.

Patients And Methods: Obese patients (n = 588) starting a weight management program were enrolled.

Clinical pharmacy specialist implementation of lisinopril therapy in patients with coronary artery disease and diabetes mellitus.

Study Objective: As the results of the Heart Outcomes Prevention Evaluation trial suggested that patients with both coronary artery disease (CAD) and diabetes mellitus would benefit from angiotensin-converting enzyme (ACE) inhibitor therapy, our objective was to increase the percentage of patients with both of these conditions receiving the goal dosage (20 mg/day) or highest tolerated dosage of the ACE inhibitor lisinopril through intervention of a clinical pharmacy service.

Study Design: Prospective study with historic comparison (control group).

Setting: Clinical Pharmacy Cardiac Risk Service.