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Coronary artery disease (CAD) patients are facing life-long commitment to change their health habits. It is necessary for these patients to maintain their health habits even after discharge by nursing intervention. The purpose of this study was to analyze the follow-up nursing management consisting of personal interviews and telephone coach after discharge to CAD patients. The data were collected from 35 CAD patients between June, 12, 2005 and October, 19, 2005. Data were processed by SPSSWIN V.13.0 program with descriptive statistics. The results of this study were as follows: 1. The proportion of the subjects were male patients(82.9%), married(94.3%), over high school(71.4%), having a job(71.4%), middle socio-economic state(65.7%) and everage age was 55.4 years. 2. The average hospital days for the subjects were 3.0days, with 20.31 months for the period since their diagnosis of CAD. About 85.7% of the subjects reported no family history of heart disease, while 80% is diagnosed for angina among whom 57.1% has comobity of diabetes or hypertension. 22.9% are smokers, 48.6% are drinking alcohol more than once a week, 65.7% drinks coffee, and 34.3% are doing exercise regularly. Most subjects (91.4) never receive CAD related formal education. 3. The checklists for patients’ counselling areas by personal interview and telephone couch includes exercise, medication, stress management, diet, weight control, smoking cessation, glucose control, sex behavior, hospital visit schedule, and changes in their employment. 4. According to time frame for their specific counselling needs, the areas of medication, diet, weight control, glucose control, and sex behavior were the main concern during the first 2 weeks after discharge. The areas of exercise and smoking cessation was the focus of counselling during the following 2 weeks. After 4 weeks of discharge, the major concern of the subjects was about stress management. In conclusion, there were major areas of concern for CAD patients after discharge as reported by a personal interview and telephone couch, and those concerns were different according to the time frame after their discharge. There is a need to develop the formal nursing management program that can be applied easily and effectively to CAD patients at outpatient clinic after discharge according to their education needs. The study findings supported the potential cost-effectiveness of the follow-up nursing management program utilizing a nurse-led interview and a series of telephone couch.
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