Management of coronary atherosclerotic heart disease through an alliance of community and hospital

Objective To evaluate the effect of out-hospital normalized management of coronary heart disease (CAD) on the end point events such as mortality, readmission, etc, and on the compliance of patients through normalized management by an alliance of community and hospital. Methods The samples were comprised of a total of 2000 patients in 15 communities. And 1642 patients agreed to a follow-up and signed a consent form. Ten communities were chosen as the intensive management group in which community clinicians were trained and the patient management plan was proposed and carried out. The remaining 5 communities were taken as the control group in which the community clinicians were not trained and the patients received only general management. Both groups received a follow-up of 23 months. Results Compared with the control group, the intensive manage group showed a lower risk of all-cause death, cardiac death and readmission due to cardiovascular events (CVE). They declined by 36.5% (OR 0. 635,95% CI 0.478-0.854),41.5%(OR0.585,95%CI 0.428-0.800) and 56.1%(OR0.439,95%CI0.315-0.612)respectively. The proportion of patients with NYHA Ⅲ in the intensive management and control groups increased by 3.6% and 7.7% while that of the counterparts of NYHA Ⅳ in two groups increased by 1.6% and 6. 4% respectively. The cardiac function in the patients of intensive management group was significantly superior to that in control group. Patients in both groups displayed an acceptable compliance to cardiac medications except for aspirin. The proportion of aspirin in the intensive management and control groups increased by 8.4% and 8.7% respectively (P ＜ 0.05). Conclusion Through normalized management provided by an alliance of community and hospital, the rates of all-cause death and readmission due to CVE decrease significantly concurrently with an improvement of cardiac function and quality of life in CAD patients. Key words: Coronary disease; Hospital,community; Disease management