Rationale and design of the cardiac hospitalization atherosclerosis management program at the University of California Los Angeles

Despite clear and consistent clinical-trial evidence that secondary-prevention medical therapies reduce mortality in patients with established coronary artery disease, these therapies are underutilized in patients receiving conventional care. To address this issue, a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP) focused on initiation of aspirin, cholesterol-lowering medication (3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitor titrated to achieve low-density lipoprotein [LDL] cholesterol <100 mg/dL), β-blocker, and angiotensin-converting enzyme (ACE)–inhibitor therapy in conjunction with diet and exercise counseling before hospital discharge in patients with established coronary artery disease was designed and implemented at the University of California Los Angeles (UCLA) Medical Center starting in 1994. This treatment program was based on the hypothesis that initiation of therapy in the hospital setting would result in higher utilization rates both at the time of discharge and during longer-term follow-up. Implementation of this program involved the use of a focused treatment guideline, standardized admission orders, educational lectures by local thought leaders, and tracking/reporting of treatment rates. To assess the impact of the program, treatment rates and clinical outcome were compared in patients discharged in the 2-year periods before and after CHAMP was implemented. Hospital-based treatment protocols such as CHAMP have the potential to significantly increase treatment utilization of therapies previously demonstrated to improve survival and thus substantially improve the outcome of the 2 million patients diagnosed and hospitalized each year with coronary artery disease.