July 2004

Patients take heart from award-winning program

More than 1,000 patients enrolled in 2003 in the multi-award winning COACH disease management project for people who have recurring heart disease.

The Department of Human Services-funded COACH Program runs in four Melbourne teaching hospitals—St Vincent’s, Austin Health, the Royal Melbourne Hospital and the Alfred Hospital—and at the Melbourne Division of General Practice.

The 1,000-plus enrolment represents 35 per cent of patients with coronary heart disease eligible for ‘coaching’.

‘Coaching’ is a proven method of training patients to achieve and maintain target levels for specific modifiable risk factors and reduce re-admissions to hospital.

Patients who have coronary heart disease have up to seven times the chance of having another heart attack compared with someone who has not had coronary heart disease.

Studies have shown that, if patients with coronary heart disease lowered their cholesterol level, lowered their blood pressure, stopped smoking, did regular exercise and followed a good diet, the risk of heart attack recurrence was substantially lowered.

Co-author of these studies, Dr Margarite Vale from the Department of Cardiology and the University of Melbourne’s Department of Medicine at St Vincent’s Hospital in Melbourne, said the problem had been that many patients were not achieving the target levels for these risk factors for coronary heart disease.

‘We developed the COACH Program to help more patients achieve these treatment goals,’ said Dr Vale.

The studies and resultant COACH Program have earned Dr Vale several awards, including the 2003 Premier’s Commendation for Medical Research, the 2002 Ralph Reader Prize (Young Investigator Award) for Clinical Science by the Cardiac Society of Australia and New Zealand and the Young Investigator Award at the 5th International Conference on Preventive Cardiology in 2001.

Dr Vale designed the COACH Program to enable a dietitian or nurse—a ‘cardiac coach’—to train patients to vigorously pursue the target levels for their coronary risk factors while working with their usual doctors.

‘Coaching is about the aggressive pursuit of risk factor targets,’ said Dr Vale.

‘The target levels that we aim for are those recommended by the National Heart Foundation of Australia for patients with pre-existing coronary heart disease.

‘The coach uses the telephone and mail-outs to provide regular coaching sessions to patients after discharge from hospital.

‘Coaching sessions are provided regularly for as long as necessary until the target levels for the patients’ risk factors are achieved.’

Dr Vale said the evidence from randomised, controlled trials of COACH Program patients had shown all risk factors had improved from their baseline status in hospital to six months later and there was a high compliance with recommended medication.

‘Experience from the controlled trials suggests that this will translate into reduction in hospital admissions and eventually a better survival in patients undergoing coaching.’

Dr Vale said the COACH Program team hoped to place a ‘coach’ in every hospital with a coronary care unit and every division of general practice in Australia.

She said ‘coaching’ was applicable to any disease—including diabetes, obesity, heart failure, osteoporosis and asthma—that involved the taking of medication as well as altered lifestyle to improve outcomes.