Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Aug 2022)

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. Neeland,
  • Sadeer G. Al‐Kindi,
  • Nour Tashtish,
  • Elke Eaton,
  • Janice Friswold,
  • Sara Rahmani,
  • Khendi T. White‐Solaru,
  • Imran Rashid,
  • Diamond Berg,
  • Mariam Rana,
  • Claire Sullivan,
  • Betul Hatipoglu,
  • Peter Pronovost,
  • Sanjay Rajagopalan

DOI
https://doi.org/10.1161/JAHA.120.024482
Journal volume & issue
Vol. 11, no. 15

Abstract

Read online

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.

Keywords