ArticlesNurse-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
Introduction
The scientific evidence for cardiovascular disease prevention is compelling;1 it shows that lifestyle intervention, risk factor management, and cardioprotective drugs can reduce cardiovascular morbidity and mortality in patients with established atherosclerotic disease and those at high risk (Systemic COronary Risk Evaluation [SCORE]) of developing the disease.1, 2 However, results of risk factor management in patients with coronary heart disease in the European Action on Secondary and Primary prevention through Intervention to Reduce Events (EUROASPIRE)3, 4, 5 study showed that cardiovascular disease prevention in routine clinical practice is inadequate. Most patients are not referred to a cardiac rehabilitation programme and less than a third attend.6 The EUROASPIRE4, 5 survey in 2000 described the management of coronary patients as a “collective failure of medical practice”. The EUROACTION model was developed by the European Society of Cardiology to help patients with coronary heart disease, high multifactorial risk, and diabetes outside specialist cardiac rehabilitation centres to achieve the lifestyle, risk factor, and therapeutic targets defined in the prevention guidelines in routine clinical practice.7 The aim of this study was to assess whether a nurse-coordinated, multidisciplinary, family-based, ambulatory, preventive cardiology programme (EUROACTION) in hospital and general practice could increase the proportions of patients and their families achieving the goals for cardiovascular disease prevention compared with usual care (panel).8
Section snippets
Study population
A matched, paired cluster-randomised controlled trial (figure 1) was done in 12 (six pairs) general hospitals in France, Italy, Poland, Spain, Sweden, and the UK, and 12 (six pairs) general-practice centres in Denmark, Italy, Poland, Spain, the Netherlands, and the UK. Hospitals and primary-care centres were randomly assigned to intervention or usual care. The trial started in April, 2003, and was completed in September, 2006.
Consecutive patients (men and women) were prospectively identified.
Results
Table 1 shows patients and their partners' demographics, participation, and 1-year assessments in hospital and general-practice centres. Table 2 shows the results of the initial assessments and the proportions of patients and their partners achieving lifestyle, risk factor, and drug targets for cardiovascular disease prevention. Figure 1 shows the trial profile.
Among patients with coronary heart disease who reported smoking in the month before their cardiac event, a higher proportion in the
Discussion
The EUROACTION preventive cardiology programme reduced the risk of cardiovascular disease compared with usual care mainly through lifestyle changes by families, who together made healthier food choices and became more physically active than before the intervention. This change led to some weight loss and, for high-risk patients, a reduction in central obesity. Blood pressure control was improved and for patients with coronary heart disease without the use of additional antihypertensive drugs.
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