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

Abstract

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). CCCS works collaboratively with patients, primary care physicians, cardiologists, and other health care professionals to coordinate proven cardiac risk reduction strategies for patients with CAD. Activities such as lifestyle modification, medication initiation and adjustment, patient education, laboratory monitoring, and management of adverse events are all coordinated through CCCS. The CCCS uses an electronic medical record and patient-tracking software to document all interactions with patients, track patient appointments, and collect data for evaluation of both short- and long-term outcomes.

Outcomes: The CCCS currently follows over 12,000 patients with CAD. The CCCS has demonstrated improvement in surrogate outcomes including: cholesterol screening (55% to 96.3%), the proportion of patients with a goal of low-density lipoprotein cholesterol (LDL-c) <100 mg/dL (22% to 76.9%), and has reduced the average LDL-c to 78.3 mg/dL for the CAD population it follows. The CCCS has shown a reduction in all-cause mortality associated with CAD by 76% in the patients followed by the service. Patient and physician satisfaction have been high with CCCS.

Conclusion: The CCCS coordinates many aspects of cardiac risk reduction care resulting in excellent continuity of care. The CCCS has continued to grow and expand the number of patients enrolled by using innovative strategies and technology and has resulted in excellent care and improved outcomes of the CAD population at KPCO.

Figures

Figure 1

Kaplan-Meier curves for all-cause and cardiac-related mortality by year: All cause. CCCS = Collaborative Cardiac Care Service

Figure 2

Kaplan-Meier curves for all-cause and cardiac-related mortality by year: Cardiac related. CCCS = Collaborative Cardiac Care Service Note: Patients with a CAD event were categorized into one of four cohorts by time to enrollment into the Collaborative Cardiac Care Service relative to cardiac event: enrolled within (early CCCS) or outside (delayed CCCS) 90 days of cardiac event; enrolled intermittently (intermittent CCCS); or never enrolled (No CCCS). Merenich JA, Olson KL, Delate T, Rasmussen J, Helling DK, Ward DG; Clinical Pharmacy Cardiac Risk Service Study Group. Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease. Reprinted with permission from Pharmacotherapy.