Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial

Wood, D; Kotseva, Kornelia; Connolly, Susan; Jennings, Catriona; Mead, A; Jones, Joanne; Holden, A; Bacquer, Dirk De; Collier, Tim; Backer, Guy De; Færgeman, Ole

doi:10.1016/s0140-6736(08)60868-5

Cited by 528 publications

(495 citation statements)

References 35 publications

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“…The extent to which the risk factors, when present, were modified in our cohort was comparable to the intervention groups in previously published studies. Thus, there was sustainable weight loss in those who were overweight,36, 37 lowering of blood pressure in those with high levels,38 improvement of the lipid profile and insulin resistance in those with baseline abnormalities,33, 39 and promotion of a healthy diet and exercise habits,33, 40, 41 findings similar to observations in high‐risk populations 42, 43. Importantly, no perceptible decline among those with relatively normal values was observed, indicating that health was maintained in this cohort.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Mheid

Kelli

et al. 2016

JAHA

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BackgroundLifestyle modifications are first‐line measures for cardiovascular disease prevention. Whether lifestyle intervention also preserves cardiovascular health is less clear. Our study examined the role of a Health Partner–administered lifestyle intervention on metrics of ideal cardiovascular health.Methods and ResultsA total of 711 university employees (48±11 years; 66% women, 72% Caucasian/22.5% African Americans) enrolled in a program that promoted healthier lifestyles at Emory University (Atlanta, GA). Anthropometric, laboratory, and physical activity measurements were performed at baseline and at 6 months, 1 year, and 2 years of follow‐up. Results were utilized by the Health Partner to generate a personalized plan aimed at meeting ideal health metrics. Compared to baseline, at each of the 6‐month, 1‐year, and 2‐year follow‐up visits, systolic blood pressure was lower by 3.6, 4.6, and 3.3 mm Hg (P<0.001), total cholesterol decreased by 5.3, 6.5, and 6.4 mg/dL (P<0.001), body mass index declined by 0.33, 0.45, and 0.38 kg/m2 (P<0.001), and the percentage of smokers decreased by 1.3%, 3.5%, and 3.5% (P<0.01), respectively. Changes were greater in those with greater abnormalities at baseline. Finally, the American Heart Association “Life's Simple 7” ideal cardiovascular health score increased by 0.28, 0.40, and 0.33 at 6 month, 1 year, and 2 years, respectively, compared to baseline visit.ConclusionsA personalized, goal‐directed Health Partner intervention significantly improved the cardiometabolic risk profile and metrics of cardiovascular health. These effects were evident at 6 months following enrollment and were sustained for 2 years. Whether the Health Partner intervention improves long‐term morbidity and mortality and is cost‐effective needs further investigation.

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Section: Discussionmentioning

confidence: 99%

Effects of a Health‐Partner Intervention on Cardiovascular Risk

Mheid

Kelli

et al. 2016

JAHA

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“…Other CVD primary prevention studies achieved larger effects but required greater resources, and many included multiple contacts with clinicians. 8,10,11,[21][22][23][24] If a measurable positive effect of a more limited intervention like ours can be accomplished at a sufficiently low cost, it may be a worthwhile approach to adopt. If the process of delivering these messages can be fully automated (such as using a patient portal connected to the electronic health record), this may reduce the cost of providing this service further.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

et al. 2012

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BACKGROUND: Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness. OBJECTIVE AND DESIGN: To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care. PARTICIPANTS: Patients of participating physicians with a Framingham Risk Score of at least 5 %, lowdensity lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis. INTERVENTION: Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant). MAIN MEASURES: The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311. KEY RESULTS: Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P=0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1. 05-4.32, p=0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P=0.029). CONCLUSIONS: In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL-cholesterol after 9 months. With longer follow-up, the intervention's effect on LDL-cholesterol levels was apparent.

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“…El manejo óptimo de la HTA reduce la incidencia de re-infarto, muerte por EC y ACV [20][21] . Treinta por ciento de los pacientes alcanzaron metas de PA < 130/85 mmHg y sólo 23,6% de aquellos con 3 o más FR.…”

Section: Discussionunclassified

“…En conclusión, los datos obtenidos de forma global, no se alejan de la realidad mundial. Sin embargo, se requieren mayores esfuerzos para fortalecer las normas de manejo en pacientes coronarios e incorporar a la práctica estrategias de prevención secundaria tales como educación por enfermera previa al alta hospitalaria, reforzar el abandono del tabaquismo, monitorización de la terapia farmacológica y fomentar un estilo de vida saludable, incorporando la actividad física y una alimentación equilibrada 21,31,32 .…”

Section: Discussionunclassified

“…Para evaluar el logro de metas se utilizaron los objetivos establecidos por el Programa de Salud Cardiovascular implementado por el Ministerio de Salud-Chile: abandono del tabaquismo, PA < 130/85 mm Hg, colesterol total (CT) < 200 mg/ dL, triglicéridos < 150 mg/dL, colesterol HDL > 40 mg/dL, colesterol LDL < 100 mg/dL (deseable < 70 mg/dL), hemoglobina glicosilada < 7%, índice de masa corporal (IMC) normal (18,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)9 kg/m 2 ), PC < 102 cm en hombres y < 88 cm en mujeres y prescripción de fármacos de acción CV en dosis adecuadas 14 . Los eventos CV mayores fueron: angioplastía coronaria percutánea (ACP) de urgencia o electiva, cirugía de revascularización miocárdica (CRM) electiva o de urgencia, nuevo infarto agudo al miocardio (IAM) con elevación del segmento ST, síndrome coronario agudo (SCA) sin elevación del segmento ST y accidente cerebro vascular (ACV).…”

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