A Kiessling

Anna Kiessling

LA Mauffette-Leenders

Peter Henriksson

English

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Case method assisted implementation of guidelines on secondary prevention of coronary artery disease decreases mortality: a ten-year follow up of a randomized controlled study

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MEETING ABSTRACT Open AccessCase method assisted implementation ofguidelines on secondary prevention of coronaryartery disease decreases mortality: a ten-yearfollow up of a randomized controlled studyAnna Kiessling*, Peter HenrikssonFrom Knowledge transfer in primary care: the model of allergic respiratory diseasesQuebec City, Canada. 7 May 2010Previous findings show, two years after Primary CarePractitioners’ participation in an interactive pedagogiccase-based learning program [1], that a significant reduc-tion of blood lipid levels of their patients was achieved[2], and reported that the educational intervention wascost effective [3]. The aim of this study was to determinethe size of any patient survival benefit from such interac-tive case-based learning method [1] aimed at facilitatingimplementation of guidelines in primary care.This was a prospective randomized controlled trial in aprimary care practice setting, in Stockholm, Sweden. Newguidelines for secondary prevention in coronary artery dis-ease were mailed to all general practitioners in the areaand presented at a common lecture in 1995. The generalpractitioners were randomized according to their PrimaryHealth Care Center into well-matched patient/physicianpairs and were randomly allocated to active interventionwith either exposure to a case-based learning method orusual care. General practitioners in the intervention groupparticipated in recurrent case-based learning dialogues attheir Primary Health Care Centers during a two-year per-iod. A locally well-known cardiologist served as the facili-tator. Consecutive patients (n=255) with coronary arterydisease were included. Ten-year mortality rates wereobtained from the Cause of Death register and wereassessed as all cause and cardiovascular mortality.The two Primary Health Care Center groups ofpatients and physicians were well matched and did notdiffer at baseline. The attendance rate at the seminarswas 82% or higher. After ten years, nineteen (44%) ofthe patients included in the control group had deceasedcompared to 10 (22%) in the intervention group(p=0.017; log rank test). The inclusion of the covariatesage, sex, hypertension, smoking and diabetes did notchange the results. Patients treated by a specialist diedat a rate comparable to the intervention group (23%).Cardiovascular mortality was 32% in the control groupand 16% in the intervention group (p=0.007).In conclusion, case-based learning methods for generalpractitioners improved survival in patients with coronaryartery disease. The hazard ratio (HR) of survivalbetween intervention and usual care is 0.45 (95% CI0.20-0.95) if the case-based learning method is used toassist implementation of evidence based care.Published: 10 December 2010References1. Mauffette-Leenders LA, Erskine JA, Leenders MR: Richard Ivey School ofBusiness. Learning with cases. Richard Ivey School of Business The Universityof Western Ontario London Ont.; 1997.2. Kiessling A, Henriksson P: Efficacy of case method learning in generalpractice for secondary prevention in patients with coronary arterydisease: randomised controlled study. BMJ 2002, 325:877-80, andsupplementary material.3. Kiessling A, Zethraeus N, Henriksson P: Cost of lipid lowering in patientswith coronary artery disease by case method learning. Int J TechnolAssess Health Care 2005, 21:180-6.doi:10.1186/1710-1492-6-S4-A6Cite this article as: Kiessling and Henriksson: Case method assistedimplementation of guidelines on secondary prevention of coronaryartery disease decreases mortality: a ten-year follow up of arandomized controlled study. Allergy, Asthma & Clinical Immunology 20106(Suppl 4):A6.* Correspondence: anna.kiessling@ki.seKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital,Division of Cardiovascular Medicine, Stockholm, SwedenKiessling and Henriksson Allergy, Asthma & Clinical Immunology 2010, 6(Suppl 4):A6http://www.aacijournal.com/content/6/S4/A6 ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY© 2010 Kiessling and Henriksson; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

Allergy Asthma & Clinical Immunology

MEETING ABSTRACT Open Access
Case method assisted implementation of
guidelines on secondary prevention of coronary
artery disease decreases mortality: a ten-year
follow up of a randomized controlled study
Anna Kiessling*, Peter Henriksson
From Knowledge transfer in primary care: the model of allergic respiratory diseases
Quebec City, Canada. 7 May 2010
Previous findings show, two years after Primary Care
Practitioners’ participation in an interactive pedagogic
case-based learning program [1], that a significant reduc-
tion of blood lipid levels of their patients was achieved
[2], and reported that the educational intervention was
cost effective [3]. The aim of this study was to determine
the size of any patient survival benefit from such interac-
tive case-based learning method [1] aimed at facilitating
implementation of guidelines in primary care.
This was a prospective randomized controlled trial in a
primary care practice setting, in Stockholm, Sweden. New
guidelines for secondary prevention in coronary artery dis-
ease were mailed to all general practitioners in the area
and presented at a common lecture in 1995. The general
practitioners were randomized according to their Primary
Health Care Center into well-matched patient/physician
pairs and were randomly allocated to active intervention
with either exposure to a case-based learning method or
usual care. General practitioners in the intervention group
participated in recurrent case-based learning dialogues at
their Primary Health Care Centers during a two-year per-
iod. A locally well-known cardiologist served as the facili-
tator. Consecutive patients (n=255) with coronary artery
disease were included. Ten-year mortality rates were
obtained from the Cause of Death register and were
assessed as all cause and cardiovascular mortality.
The two Primary Health Care Center groups of
patients and physicians were well matched and did not
differ at baseline. The attendance rate at the seminars
was 82% or higher. After ten years, nineteen (44%) of
the patients included in the control group had deceased
compared to 10 (22%) in the intervention group
(p=0.017; log rank test). The inclusion of the covariates
age, sex, hypertension, smoking and diabetes did not
change the results. Patients treated by a specialist died
at a rate comparable to the intervention group (23%).
Cardiovascular mortality was 32% in the control group
and 16% in the intervention group (p=0.007).
In conclusion, case-based learning methods for general
practitioners improved survival in patients with coronary
artery disease. The hazard ratio (HR) of survival
between intervention and usual care is 0.45 (95% CI
0.20-0.95) if the case-based learning method is used to
assist implementation of evidence based care.
Published: 10 December 2010
References
1. Mauffette-Leenders LA, Erskine JA, Leenders MR: Richard Ivey School of
Business. Learning with cases. Richard Ivey School of Business The University
of Western Ontario London Ont.; 1997.
2. Kiessling A, Henriksson P: Efficacy of case method learning in general
practice for secondary prevention in patients with coronary artery
disease: randomised controlled study. BMJ 2002, 325:877-80, and
supplementary material.
3. Kiessling A, Zethraeus N, Henriksson P: Cost of lipid lowering in patients
with coronary artery disease by case method learning. Int J Technol
Assess Health Care 2005, 21:180-6.
doi:10.1186/1710-1492-6-S4-A6
Cite this article as: Kiessling and Henriksson: Case method assisted
implementation of guidelines on secondary prevention of coronary
artery disease decreases mortality: a ten-year follow up of a
randomized controlled study. Allergy, Asthma & Clinical Immunology 2010
6(Suppl 4):A6.
* Correspondence: anna.kiessling@ki.se
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital,
Division of Cardiovascular Medicine, Stockholm, Sweden
Kiessling and Henriksson Allergy, Asthma & Clinical Immunology 2010, 6(Suppl 4):A6
http://www.aacijournal.com/content/6/S4/A6 ALLERGY, ASTHMA & CLINICAL 
IMMUNOLOGY
© 2010 Kiessling and Henriksson; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.


Kiessling Anna

Henriksson Peter

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Allergy Asthma and Clinical Immunology

Cost of lipid lowering in patients with coronary artery disease by case method learning.

Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden Kiessling and Henriksson Allergy,

Henriksson P: Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study. BMJ 2002, 325:877-80, and supplementary material.

Leenders MR: Richard Ivey School of Business. Learning with cases.

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Case method assisted implementation of guidelines on secondary prevention of coronary artery disease decreases mortality: a ten-year follow up of a randomized controlled study

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