UCLA heart care program improves treatment, cuts repeat heart attacks and lowers mortality

New program could save 40,000 lives annually if implemented nationwide

In the first hospital-based program of its kind, UCLA developed a new protocol for cardiac care that effectively improves treatment for patients hospitalized with coronary artery disease - at no extra cost to the hospital.

The program resulted in higher treatment rates with survival-enhancing medications that dramatically surpass national levels. More than 40,000 patients could be saved annually if hospitals nationwide implemented the UCLA program.

Reported in the April edition of the American Journal of Cardiology, the UCLA program, called CHAMP (Cardiovascular Hospitalization Atherosclerosis Management Program), tested well with heart attack patients - increasing treatment rates, cutting repeat hospitalizations in half and increasing tenfold the number of patients achieving an LDL cholesterol level lower than 100 mg/dl, which is critical to cardiac health in this high-risk population.

"We've found the solution to improving patient compliance. By initiating treatment in the hospital, patients better understood how important the medications are to their long-term health and were more likely to remain on therapy," said Dr. Gregg Fonarow, principal investigator, UCLA associate professor of medicine and director, Ahmanson-UCLA Cardiomyopathy Center. "The results are so striking that this approach should become the standard of care."

Fonarow notes that the program's success also lies in its simplicity. Under the CHAMP protocol, every patient admitted to UCLA with coronary artery disease receives an initial lipid-panel, which measures cholesterol levels. Key medications are then prescribed depending on the patient's condition and type of cardiac problem such as heart attack, undergoing bypass surgery or balloon angioplasty, unstable angina, stroke, or peripheral vascular disease. Diet, exercise and smoking-cessation counseling follow.

In the study, researchers compared the differences in treatment outcomes both before and after implementation of the CHAMP program with heart attack patients admitted to UCLA Medical Center. A total of 558 adults were assessed: 256 before CHAMP and 302 after the program was initiated.

UCLA researchers found better utilization by physicians and adherence by patients after implementation of the CHAMP program. At hospital discharge, aspirin use improved from 68 percent to 92 percent, beta-blocker use increased from 12 percent to 62 percent, ACE-inhibitor usage jumped from 6 percent to 58 percent and statin use rose dramatically from 6 percent to 86 percent. The marked improvement was maintained at the one-year follow-up.

"The statin treatment rate of 86 percent seen with CHAMP is almost three times higher than the national average," Fonarow said. "This is significant since statins can significantly lower the risk of mortality after a heart attack. For example, the Simvastatin Survival Study (4S) demonstrated a 42 percent reduction in cardiac mortality with statin treatment."

According to Fonarow, more patients with coronary artery disease nationwide need to be on risk-reduction programs such as CHAMP. A recent UCLA report in Circulation, the journal of the American Heart Association, showed that nationwide only 32 percent of heart attack patients were discharged from the hospital on lipid-lowering medications, such as statins.

CHAMP also resulted in a significant improvement in patient health. The number of heart attack patients achieving an LDL cholesterol level below 100 mg/dl increased from 6 percent to 58 percent. Repeat heart attacks and one-year mortality rates were cut by more than half, being reduced from 14.8 percent to 6.4 percent with CHAMP.

The CHAMP program reduces the risk of coronary artery disease through prescribing lipid-lowering medications, such as statin drugs, and other key medications at the time of hospitalization. Traditionally, such treatments are introduced much later, often weeks and even months after the patient goes home from the hospital. Numerous studies have shown that waiting until after the patient has gone home to start risk-factor management leads to lower treatment rates for coronary artery disease.

According to Fonarow, CHAMP achieved a major level of success without extra costs because the program is direct, focused and uses existing hospital resources. The entire hospital team works with the patient, from the physician and pharmacist to the cardiac nurse in implementing CHAMP.

"CHAMP offers a comprehensive, multidisciplinary plan to help patients. We hope other hospitals will follow our lead," Fonarow said. "Getting patients on treatments that target their underlying atherosclerosis disease process, which is what got them in trouble in the first place, is crucial to the patient's health. By developing a better way to get our cardiovascular disease patients on treatment, we saved lives."

A new program from the American Heart Association called "Get With the Guidelines," builds on the UCLA CHAMP program. The association's goal is to help hospitals nationwide embrace the American Heart Association secondary prevention guidelines, helping more high-risk cardiac patients achieve a healthier lifestyle and lifespan. More than 2.5 million are hospitalized annually with cardiac disease.

For more information about the CHAMP program, please see the following Web site: http://www.med.ucla.edu/champ.