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Coaching patients On Achieving Cardiovascular Health (COACH)
A Multicenter Randomized Trial in Patients With Coronary Heart Disease
Margarite J. Vale, PhD(Melb), BScEd(Melb), MNutDiet(Syd), Dip EpidBiostat(Melb);
Michael V. Jelinek, MD, FRACP, FACC;
James D. Best, MD, FRACP, FRCPath;
Anthony M. Dart, DPhil, FRCP(UK);
Leeanne E. Grigg, MBBS, FRACP;
David L. Hare, MBBS, DPM, FRACP, FRANZCP;
Betty P. Ho, MBBS, FRACP;
Robert W. Newman, MBBS, FRACP;
John J. McNeil, PhD(Melb), MSc, FRACP, FAFPHM; for The COACH Study Group
Arch Intern Med. 2003;163:2775-2783.
Background Disease management programs in which drugs are prescribed by dietitians or nurses have been shown to improve the coronary risk factor profile in patients with coronary heart disease. However, those disease management programs in which drugs are not prescribed by allied health professionals have not improved coronary risk factor status. The objective of the Coaching patients On Achieving Cardiovascular Health (COACH) study was to determine whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol (TC) and other risk factors.
Methods Multicenter randomized controlled trial in which 792 patients from 6 university teaching hospitals underwent a stratified randomization by cardiac diagnosis within each hospital: 398 were assigned to usual care plus The COACH Program and 394 to usual care alone. Patients in The COACH Program group received regular personal coaching via telephone and mailings to achieve the target levels for their particular coronary risk factors. There was one coach per hospital. The primary outcome was the change in TC ( TC) from baseline (in hospital) to 6 months after randomization. Secondary outcomes included measurement of a wide range of physical, nutritional, and psychological factors. The analysis was performed by intention to treat.
Results The COACH Program achieved a significantly greater TC than usual care alone: the mean TC was 21 mg/dL (0.54 mmol/L) (95% confidence interval [CI], 16-25 mg/dL [0.42-0.65 mmol/L]) in The COACH Program vs 7 mg/dL (0.18 mmol/L) (95% CI, 3-11 mg/dL [0.07-0.29 mmol/L]) in the usual care group (P<.0001). Thus, the reduction in TC from baseline to 6 months after randomization was 14 mg/dL (0.36 mmol/L) (95% CI, 8-20 mg/dL [0.20-0.52 mmol/L]) greater in The COACH Program group than in the usual care group. Coaching produced substantial improvements in most of the other coronary risk factors and in patient quality of life.
Conclusions Coaching, delivered as The COACH Program, is a highly effective strategy in reducing TC and many other coronary risk factors in patients with coronary heart disease. Coaching has potential effectiveness in the whole area of chronic disease management.
From the Department of Cardiology and The University of Melbourne Department of Medicine (Drs Vale, Jelinek, Best, Grigg, Hare, and Newman); St Vincent's Hospital Melbourne (Drs Vale, Jelinek, and Best); Baker Heart Research Institute and Alfred Hospital, Monash University (Dr Dart); The Royal Melbourne Hospital (Dr Grigg); Austin and Repatriation Medical Centre (Dr Hare); Department of Cardiology and Monash University Department of Medicine, Monash Medical Center (Dr Ho); Western Hospital Footscray (Dr Newman); and Department of Epidemiology and Preventive Medicine, Monash University Medical School, Alfred Hospital (Dr McNeil); Melbourne, Australia. Dr Best is a member of the Lipid Advisory Committee for Merck Sharp and Dohme, Pfizer, and Astra Zeneca. Drs Dart and Hare are members of the Lipid Advisory Committee for Merck Sharp and Dohme.
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