Elevate Your Health Colorado Heart Attacks: Coordinated care increases survival

Heart disease has long been the nation’s No. 1 killer, claiming the lives of more than 900,000 Americans a year – that’s about 9,000 lives annually in Colorado. For those who survive a cardiac event, such as a heart attack, the likelihood of another life-threatening incident is very high. In fact, studies show that fewer than 20 percent are expected to survive 10 years.

Today, that’s changing. Thanks to an innovative program piloted by Kaiser Permanente Colorado, patients who have survived a heart attack are living longer and getting a second chance.

Shirley Kuta, 72, is one of those patients. She survived a heart attack in 2000, and the outreach team has been monitoring her medications, diet, and exercise ever since. She looks forward to regular calls from her pharmacist. “He makes sure my heart is protected – let me tell you,” she says. Thanks to the team’s efforts, Kuta insists she’ll live to 100.

About coronary artery disease
Many types of heart disease are caused by coronary artery disease. This condition occurs when the lining of the heart’s arteries becomes damaged from plaque, which is a buildup of cholesterol and other substances that cause arteries to harden and narrow. When plaque ruptures, it leads to clotting and heart attacks.

“We recognized early on that rehabilitation is essential to recovery from heart attacks and coronary events,” says John J. Reusch, MD, a board-certified cardiologist at Kaiser Permanente Colorado. Today, Kaiser Permanente patients who have been hospitalized for a heart attack, stent, or bypass surgery are enrolled in a unique care coordination program, known as the Collaborative Cardiac Care Service, or CCCS.

“This program has reduced death rates among patients with coronary artery disease by 76 percent – compared to those who don’t get this level of care,” Dr. Reusch says. That’s good news for the 13,000 people in Colorado currently enrolled. As a result of this program, it’s estimated that hundreds of lives are potentially saved and more than 250 hospitalizations are prevented each year, according to the latest research.

Covering all fronts
Kaiser Permanente employs an outreach team that makes sure patients have the information, encouragement, and medication to manage their condition successfully. The program provides a multi-disciplinary approach from primary care physicians, cardiologists, endocrinologists, cardiac nurses, dietitians, exercise physiologists, and clinical pharmacists.

Shortly after patients are discharged from the hospital, nurses call them to make sure they are taking their medications and coping with recommended lifestyle changes. Follow-up calls continue regularly those first few months, then annually thereafter.

Over the phone and during follow-up appointments, the team works with patients to make sure they reduce blood pressure and cholesterol levels by eating a healthy diet, exercising regularly, and taking prescribed medications. Patients who smoke can also get help quitting by participating in a one-on-one smoking cessation program. “We act as coaches, working with patients to help them achieve their goals,” says Susan Kuca, RN, a nurse on the CCCS team at Kaiser Permanente Colorado.

“The clinical pharmacy team helps patients get placed on the right medications – and stay on them,” adds Jon Rasmussen, PharmD, a pharmacist on the CCCS team at Kaiser Permanente Colorado. “Traditionally, about 50 percent of all patients stop taking cholesterol lowering medication within a year after starting. In our program, 85 percent are still on their medication at one year. And at four years, our adherence rate is still at 75 percent – the highest rate ever documented.”

Electronic medical records help facilitate communication among all care providers, giving patients the peace of mind that the entire team is involved in their recovery progress. Lab results also are available through a secure Web site.

Patients in a cardiac rehabilitation program can benefit greatly from access to care online. At Kaiser Permanente, this means logging on to My health manager to e-mail health care providers, access test results, refill prescriptions, and schedule appointments. “If patients have questions about their medications and lab results, they can e-mail them directly to us,” Rasmussen continues. “It’s a time-saving service our patients really appreciate.”

Proven results
Results published in several medical journals, including Pharmacotherapy, show that patients who participate in the CCCS program have positive outcomes.

• When enrolled within 90 days of a heart attack, patients have an 88 percent reduced risk of dying of a cardiac-related cause, compared to those not in the program.
• The number of patients meeting their cholesterol goals has increased from 26 percent to 73 percent.
• The number of patients screened for cholesterol has increased from 55 percent to 97 percent.

“Because this program has been so successful, it has attracted national attention from officials overseeing health care reform. This past March, program results were presented at a briefing in Washington, D.C. cosponsored by the Alliance for Health Care Reform, Kaiser Permanente, and the AFL-CIO.

“With proper care, coronary artery disease can remain a manageable condition, without escalating into a life-threatening crisis,” Dr. Reusch says.

To learn more about preventing heart attacks, visit KaiserPermanente.org.

Dr. Reusch received his medical degree from the University of Minnesota Medical School and completed his internship, residency, and fellowship training at University of Colorado Health Sciences Center. He is board certified in cardiology and internal medicine, with a subspecialty in cardiovascular disease.