MODIFICATION OF CORONARY RISK FACTORS SOON AFTER MI

本研究项目旨在对风险进行评估。 心肌梗死后不久开始的因子修改 (Mi)可以广泛实施的。《家》 治疗计划(HTP)提供戒烟和 心肌梗死后一年的饮食/药物治疗高脂血症。 吸烟和高脂血症的护士干预 从第四个住院日开始。这些活动的强度 干预措施是根据个别患者的需要量身定做的。一个 项目护士主要通过以下方式维持HTP的连续性 系统的护士发起的电话联系方式 患者，并在必要时，通过面对面接触 在戒烟方面需要特殊帮助的患者，和/或 饮食管理。监测患者在HTP中的进展 是根据患者对邮寄的书面状态报告的评分 每隔一段时间向项目护士提供系统反馈 患者基于他们的状态报告由计算机提供- 生成进度报告和护士发起的电话联系。 在30个月的时间里，720名男性和女性从心肌梗死中恢复 在旧金山湾区的4家Kaiser-Permanente医院 将被随机分配到以家庭为基础的治疗方案中 吸烟和/或高脂血症或日常护理。测量的端点 在第一年年底和研究结束时是 戒烟率和血浆总胆固醇。成本 HTP的有效性通过以下方式提高 监控和补救系统以及是否提供 全面的计算机化数据库，以指导干预。 一个大学研究小组协调的能力 对大量患者进行多次治疗的干预 医院进一步提高了研究的成本效益。 这种居家医疗自助式护理模式的疗效观察 护理已经在治疗项目中得到了证明。 吸烟和高脂血症是由调查人员引起的。 展示这一新的具有成本效益的系统的成功 对于多因素风险因素的修改将奠定基础 用于评估风险因素的影响的扩展研究 改善心肌梗死后患者的发病率和死亡率。

This research project is designed to evaluate a system for risk factor modification commencing soon after myocardial infarction (MI) that can be implemented on a wide scale. The Home Treatment Program (HTP) provides smoking cessation and diet/drug treatment of hyperlipidemia in the year after MI. Nurse-mediated interventions for smoking and hyperlipidemia commence on the 4th hospital day. The intensity of these interventions is tailored to the needs of individual patients. A project nurse maintains the continuity of the HTP primarily by means of systematic nurse-initiated telephone contacts with patients and, where necessary, by face-to-face contact with patients requiring special assistance in smoking cessation, and/or dietary management. Monitoring of patients' progress in the HTP is by patients' ratings on written status reports which are mailed to the project nurse at specified intervals Systematic feedback to patients based on their status reports is provided by computer- generated progress reports and nurse-initiated telephone contacts. Over a 30-month period 720 men and women recovering from MI in 4 Kaiser-Permanente hospitals in the San Francisco Bay area will be randomized to home-base programs for treatment of smoking and/or hyperlipidemia or usual care. Endpoints measured at the end of the first year and at the end of the study are smoking abstinence rate and total plasma cholesterol. The cost effectiveness of the HTP is enhanced by the efficiency of the monitoring and remediation system and by the availability of a comprehensive computerized database to guide the interventions. The ability of a single university research group to coordinate intervention for large numbers of patients treated in multiple hospitals further enhances the cost effectiveness of the study. The efficacy of this model of home-based medically-assisted self- care has already been demonstrated in programs for treatment of smoking and hyperlipidemia developed by the investigators. Demonstration of the success of this new cost-effective system for multifactorial risk factor modification will lay the groundwork for an expanded study evaluating the effect of risk factor modification on morbidity and mortality in post-MI patients.