Chronic Disease

Telephone coaching following hospitalization for acute coronary syndrome adds little to in-hospital counseling

Individuals who received telephone coaching for 3 months after being hospitalized for acute coronary syndrome (severe chest pain or heart attack) were 1.5 times more likely to engage in exercise for those 3 months, even though that declined once the telephone counseling ended. However, there was no significant difference between the counseled and noncounseled groups in medication use, odds of smoking cessation, and participation in weight loss efforts 3 and 8 months after hospital discharge, and no difference in functional status or quality of life 8 months after discharge.

One reason may be that the telephone counseling came on top of an ongoing quality improvement (QI) program in which patients consistently received standard in-hospital counseling, which appeared to be effective. The QI protocol required in-hospital counseling and a discharge patient contract that provided the patient with numerical values for cardiac ejection fraction (indicative of the pumping power of the heart) and cholesterol, and that made recommendations for medications and lifestyle changes.

In hospitals that do not have QI protocols, telephone counseling may act as a reminder to a patient to raise these issues with a clinician, notes Margaret Holmes-Rovner, Ph.D., of Michigan State University. Her group randomized patients hospitalized for acute coronary syndrome to an in-hospital QI program only, versus QI plus six sessions of telephone-based counseling for 3 months after hospital discharge to improve lifestyle behaviors and medication use. The study was supported in part by the Agency for Healthcare Research and Quality (HS10531).

See "Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?" by Dr. Holmes-Rovner, Manfred Stommel, Ph.D., William D. Corser, Ph.D., R.N., and others, in the September 2008 Journal of General Internal Medicine 23(9), pp. 1464-1470.

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