--- title: "Case management to reduce CVD risk in county health system. | Sutter Health" description: "Nurse and dietitian case mgmt targeting multifactor risk reduction can lead to modest improvements in CVD risk in high-risk pts in low-income, ethnic minorities" url: "https://www.sutterhealth.org/research/publications/case-mgmt-reduce-cvd-risk-county-health-system-1055312926" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Case management to reduce CVD risk in county health system. # Case management to reduce risk of cardiovascular disease in a county health care system. Ma J, Berra K, Haskell WL, Klieman L, Hyde S, Smith MW, Xiao L, & Stafford RS. _Arch Intern Med. 2009;169(21):1988-1995. doi:10.1001/archinternmed.2009.381._ 2009-11-23 ## Abstract Background: Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. Methods: We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). Results: A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 \[95% confidence interval, 7.21-8.38\] vs 8.93 \[8.36-9.49\]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (−4.2 \[18.5\] vs 2.6 \[22.7\] mm Hg; P = .003) and diastolic (−6.0 \[11.6\] vs −3.0 \[11.7\] mm Hg; P = .02) blood pressures for the CM vs usual care group. Conclusion: Nurse and dietitian CM targeting multifactor risk reduction can lead to modest improvements in CVD risk factors among high-risk patients in low-income, ethnic minority populations receiving care in county health clinics. [PubMed abstract](http://archinte.jamanetwork.com/article.aspx?articleid=1108580) ## Research topics - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Food and Nutrition](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Food+and+Nutrition%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (men with choices to improve well-being and decrease chronic disease risk).](https://www.sutterhealth.org/research/publications/hombre-rct-weight-loss-approaches-latino-men-1055312293) Rosas LG, Lv N, Azar KMJ, Xiao L, Hooker SP, Lewis MA, Zavella P, Venditti EM, Ma J. Contemp Clin Trials. pii: S1551-7144(17)30629-8. doi: 10.1016/j.cct.2018.02.019. \[Epub ahead of print\] 2018 Mar 02 - Publication ### [A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention.](https://www.sutterhealth.org/research/publications/latino-pt-centered-evidence-based-approach-to-dm-prevention-1055312326) Rosas LG, Lv N, Lewis MA, Venditti EM, Zavella P, Luna V, Ma J. J Am Board Fam Med. 31(3):364-374. doi: 10.3122/jabfm.2018.03.170280. 2018 May 01 - Publication ### [Precision lifestyle medicine: a new frontier in the science of behavior change and population health.](https://www.sutterhealth.org/research/publications/precision-lifestyle-medicine-1055312346) Ma J, Rosas LG, Lv N. Am J Prev Med. pii: S0749-3797(15)00638-8. doi: 10.1016/j.amepre.2015.09.035. \[Epub ahead of print\] 2015 Dec 01 - Publication ### [Disparities in adherence to and persistence with antihypertensive regimens: an exploratory analysis from a community-based provider network.](https://www.sutterhealth.org/research/publications/disparities-in-adherence-to-anti-htn-regimens-1055312629) Ishisaka DY, Jukes T, Romanelli RJ, Wong KS, Schiro TA. J Am Soc Hypertens. 6(3):201-9. doi: 10.1016/j.jash.2012.02.004. 2012 May 01 - Publication ### [Dyslipidemia in special ethnic populations.](https://www.sutterhealth.org/research/publications/dyslipidemia-special-ethnic-populations-1055312482) Pu J, Romanelli R, Zhao B, Azar KM, Hastings KG, Nimbal V, Fortmann SP, Palaniappan LP. Endocrinol Metab Clin North Am. 45(1):205-16. doi: 10.1016/j.ecl.2015.09.013 2016 Mar 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/case-mgmt-reduce-cvd-risk-county-health-system-1055312926#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Case management to reduce CVD risk in county health system."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/case-mgmt-reduce-cvd-risk-county-health-system-1055312926#medicalscholarlyarticle","name":"Case management to reduce risk of cardiovascular disease in a county health care system.","headline":"Case management to reduce CVD risk in county health system.","abstract":"Background: Case management (CM) is a systematic approach to supplement physician-centered efforts to prevent cardiovascular disease (CVD). Research is limited on its implementation and efficacy in low-income, ethnic minority populations. Methods: We conducted a randomized clinical trial to evaluate a nurse- and dietitian-led CM program for reducing major CVD risk factors in low-income, primarily ethnic minority patients in a county health care system, 63.0% of whom had type 2 diabetes mellitus. The primary outcome was the Framingham risk score (FRS). Results: A total of 419 patients at elevated risk of CVD events were randomized and followed up for a mean of 16 months (81.4% retention). The mean FRS was significantly lower for the CM vs usual care group at follow-up (7.80 [95% confidence interval, 7.21-8.38] vs 8.93 [8.36-9.49]; P = .001) after adjusting for baseline FRS. This is equivalent to 5 fewer heart disease events per 1000 individuals per year attributable to the intervention or to 200 individuals receiving the intervention to prevent 1 event per year. The pattern of group differences in the FRS was similar in subgroups defined a priori by sex and ethnicity. The main driver of these differences was lowering the mean (SD) systolic (−4.2 [18.5] vs 2.6 [22.7] mm Hg; P = .003) and diastolic (−6.0 [11.6] vs −3.0 [11.7] mm Hg; P = .02) blood pressures for the CM vs usual care group. 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