Lessons Learned From a Patient-Centered, Team-Based Intervention for Patients With Type 2 Diabetes at High Cardiovascular Risk: Year 1 Results From the CINEMA Program.
Ian J NeelandSadeer G Al-KindiNour TashtishElke EatonJanice FriswoldSara RahmaniKhendi T White-SolaruImran RashidDiamond BergMariam RanaClaire SullivanBetul HatipogluPeter PronovostSanjay RajagopalanPublished in: Journal of the American Heart Association (2022)
Background The care for patients with type 2 diabetes necessitates a multidisciplinary team approach to reduce cardiovascular risk, but implementation of effective integrated strategies has been limited. Methods and Results We conceptualized and initiated a patient-centered, team-based intervention called Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) at University Hospitals Cleveland Medical Center. Patients with type 2 diabetes at high risk for cardiovascular events, including those with established atherosclerotic cardiovascular disease, elevated coronary artery calcium score >100, chronic heart failure with reduced ejection fraction, and/or chronic kidney disease stages 2 to 4 were included. Herein, we present the year 1 results for the program. From May 2020 through August 2021, there were 417 referrals. Among 206 eligible patients, 113 (55%) completed a baseline and ≥1 follow-up visit through December 2021, with mean (SD) time of 105 (34) days between baseline and first follow-up visits. Mean age was 59 years, with 49% women and 37% Black patients. Patients had significant reductions from baseline in glycosylated hemoglobin (-10.8%), total cholesterol (-7.9%), low-density lipoprotein cholesterol (-13.5%), systolic blood pressure (-4.0%), and body mass index (-2.7%) ( P ≤0.001 for all). In addition, among the 129 (63%) eligible patients not on sodium-glucose cotransporter 2 inhibitor or glucagon-like peptide-1 receptor agonist at baseline, 81% were prescribed evidence-based therapy with sodium-glucose cotransporter 2 inhibitor (n=66 [51%]) and/or glucagon-like peptide-1 receptor agonist (n=67 [52%]) to reduce the risk of cardiovascular disease in the initial 3-month follow-up period. Conclusions A team-based, patient-centered approach to high-risk disease management appears to be a promising paradigm for care delivery associated with greater use of evidence-based therapies and improved control of multiple cardiovascular risk factors.
Keyphrases
- end stage renal disease
- chronic kidney disease
- cardiovascular disease
- blood pressure
- ejection fraction
- quality improvement
- healthcare
- cardiovascular risk factors
- newly diagnosed
- palliative care
- body mass index
- cardiovascular events
- coronary artery
- randomized controlled trial
- peritoneal dialysis
- prognostic factors
- physical activity
- type diabetes
- heart failure
- primary care
- adipose tissue
- skeletal muscle
- bone marrow
- heart rate
- pulmonary arterial hypertension
- polycystic ovary syndrome
- pregnant women
- pulmonary hypertension
- pulmonary artery
- affordable care act