A Holden

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

BACKGROUND Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice. METHODS In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints-measured at 1 year-were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857. FINDINGS 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (difference in change 10.4%, 95% CI -0.3 to 21.2, p=0.06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17.3%, 6.4 to 28.2, p=0.009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37.3%, 18.1 to 56.5, p=0.004), and oily fish (156 [17%] vs 81 [8%]; 8.9%, 0.3 to 17.5, p=0.04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0.005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10.4%, 0.6 to 20.2, p=0.04) and high-risk (586 [58%] vs 407 [41%]; 16.9%, 2.0 to 31.8, p=0.03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not differ between groups, but in high-risk patients the difference in change from baseline to 1 year was 12.7% (2.4 to 23.0, p=0.02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6.0%, -0.5 to 11.5, p=0.04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8.5%, 1.8 to 15.2, p=0.02) and statins (381 [37%] INT vs 232 [22%] UC; 14.6%, 2.5 to 26.7, p=0.03) were more frequently prescribed. INTERPRETATION To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients.

EUROACTION: A European Society of Cardiology demonstration project in preventive cardiology. A cluster randomised controlled trial of a multi-disciplinary preventive cardiology programme for coronary patients, asymptomatic high risk individuals and their families. Summary of design, methodology and outcomes

There is substantial scientific evidence that professional lifestyle intervention on smoking, diet and physical activity, together with control of blood pressure, cholesterol and glycaemia, and selective use of prophylactic drug therapies (aspirin and other anti-platelet therapies, beta-blockers, ACE inhibitors or A-II receptor blockers, lipid-lowering drugs and anticoagulants) can reduce cardiovascular morbidity and mortality in patients with established coronary disease, and can also reduce the risk of developing atherosclerotic disease in high risk individuals. The joint European Societies guidelines on prevention of cardiovascular disease (CVD) define priorities for preventive cardiology in clinical practice 1. The first is patients with established atherosclerotic cardiovascular disease. The second is high risk individuals from the general population with hypertension, dyslipidaemia, diabetes, or a combination of these and other risk factors which puts them at high multifactorial risk of developing CVD. The third is the families (first degree blood relatives) of both coronary patients and high-risk individuals.

Preventive Cardiology: A practical manual

BACKGROUND AND MULTIDISCIPLINARY FAMILY BASED CARDIOVASCULAR ASSESSMENT 1. Rationale for preventive cardiology programmes 2. The nurse-led multidisciplinary team 3. Identification and recruitment 4. Comprehensive multidisciplinary family based cardiovascular assessment APPLICATION OF THE ASSESSMENT FINDINGS TO MANAGE LIFESTYLE AND CARDIOVASCULAR RISK FACTORS 5. Changing lifestyles 6. Smoking cessation 7. Principles of dietary intervention 8. Physical activity and exercise 9. Principles of managing weight loss 10. Blood pressure, cholesterol and glucose 11. Cardioprotective drug therapies 12. Erectile dysfunction 13. The Health Promotion Workshop Programme 14. Data management, quality assurance and audit

EUROACTION: A European Society of Cardiology demonstration project in preventive cardiology.: A cluster randomised controlled trial of a multi-disciplinary preventive cardiology programme for coronary patients, asymptomatic high risk individuals and their

There is substantial scientific evidence that professional lifestyle intervention on smoking, diet and physical activity, together with control of blood pressure, cholesterol and glycaemia, and selective use of prophylactic drug therapies (aspirin and other anti-platelet therapies, beta-blockers, ACE inhibitors or A-II receptor blockers, lipid-lowering drugs and anticoagulants) can reduce cardiovascular morbidity and mortality in patients with established coronary disease, and can also reduce the risk of developing atherosclerotic disease in high risk individuals. The joint European Societies guidelines on prevention of cardiovascular disease (CVD) define priorities for preventive cardiology in clinical practice 1. The first is patients with established atherosclerotic cardiovascular disease. The second is high risk individuals from the general population with hypertension, dyslipidaemia, diabetes, or a combination of these and other risk factors which puts them at high multifactorial risk of developing CVD. The third is the families (first degree blood relatives) of both coronary patients and high-risk individuals.