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Choice of secondary prevention improves risk factors after acute coronary syndrome: one year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial.
  1. Julie Redfern (julieredfern{at}
  1. ANZAC Research Institute, Concord Hospital, Australia
    1. Tom Briffa (tom.briffa{at}
    1. University of Western Australia, Australia
      1. Elizabeth Ellis (elizabethellis{at}
      1. University of Sydney, Australia
        1. Saul Ben Freedman (ben{at}
        1. Concord Hospital, University of Sydney, Australia


          Objective: To determine the effect of a novel CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program on cardiovascular risk factors in acute coronary syndrome (ACS) survivors.

          Design: Single-blind randomised controlled trial.

          Setting: Tertiary referral hospital in Sydney Australia.

          Patients: 144 ACS survivors who were not accessing standard cardiac rehabilitation. Data was also collected on a further 64 ACS survivors attending standard cardiac rehabilitation.

          Intervention: CHOICE group (n=72) participated in a brief, patient-centered, modular program packaged as a clinic visit plus telephone support, encompassing mandatory cholesterol lowering and tailored preferential risk modification. Control group (n=72) participated in ongoing conventional care but no centrally coordinated secondary prevention.

          Main outcome measures: Values for total cholesterol, systolic blood pressure, smoking status and physical activity.

          Results: CHOICE and control groups were well-matched at baseline. At 12 months, the CHOICE group (n=67) had significantly better risk factor levels than controls (n=69) for total cholesterol (TC) (4.0±0.1 v 4.7±0.1mmol/L, p<0.001), systolic blood pressure (131.6±1.8 v 143.9±2.3mmHg, p<0.001), body mass index (28.9±0.7 v 31.2±0.7kg/m2, p=0.025) and physical activity (1369.1±167.2 v 715.1±103.5METS/kg/min, p=0.001) as well as better knowledge of risk factor targets. Also at one year, fewer CHOICE participants (21%) had three or more risk factors above widely recommended levels then controls (72%) (p<0.001).

          Conclusions: Participation in a brief CHOICE program significantly improved the modifiable risk profiles and risk factor knowledge of ACS survivors over 12 months. CHOICE is an effective alternative for addressing the widespread under-utilisation of existing secondary prevention programs [Current controlled trials ISRCTN42984084].

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