Background National guidance for England recommends that cardiovascular disease (CVD) should be managed as a family of diseases in the community. Here, we describe the results of such an approach.
Methods Patients with established CVD or who were at high multifactorial risk (HRI) underwent a 12-week community-based nurse-led prevention programme (MyAction) that included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions.
Results Over a 6-year period, 3232 patients attended an initial assessment; 63% were male, and 48% belonged to black and minority ethnic groups. 56% attended an end-of-programme assessment, and 33% attended a one year assessment. By the end of the programme, there was a significant reduction in smoking prevalence but only in HRI (−3.7%, p<0.001). Mediterranean diet score increased in both CVD (+1.2, p<0.001) and HRI (+1.5; p<0.001), as did fitness levels (CVD +0.8 estimated Mets maximum, p<0.001, HRI +0.9 estimated Mets maximum, p<0.001) and the proportions achieving their physical activity targets (CVD +40%, p<0.001, HRI +37%, p<0.001). There were significant increases in proportions achieving their blood pressure (CVD +15.4%, p<0.001, HRI +25%, p<0.001 and low-density lipoprotein cholesterol targets (CVD +6%, p=0.004, HRI +23%, p<0.001). Statins and antihypertensive medications significantly increased in HRI. Significant improvements in depression scores and quality-of-life measures were also seen. The majority of improvements were maintained at 1 year.
Conclusion These results demonstrate that an integrated vascular prevention programme is feasible in practice and reduces cardiovascular risk in patients with established CVD and in those at high multifactorial risk.
- Cardiovascular disease prevention
- cardiovascular risk factors
- integrated care
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Contributors SBC led all aspects of the manuscript, including statistical analyses, collation of results and manuscript preparation. KK contributed to the results interpretation and manuscript preparation. CJ led the design of the nursing intervention and also contributed to the manuscript. AA led the dietetic intervention and led on interpretation of the diet and anthropometrics data, as well as contribution to the manuscript. JJ led the physical activity intervention and collation of the physical-activity results and contributed to the mansucript. AB contributed to the manuscript and led on the public health aspect. BP was responsible for the statistical analyses. DW edited and revised the manuscript.
Funding The MyAction programme was funded by NHS Westminster and subsequently by Public Health, Westminster Council.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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