Nurse-Coordinated Multidisciplinary, Family-Based Cardiovascular Disease Prevention Programme - EUROACTION

Description:

The goal of the study was to evaluate a nurse-led approach to lifestyle intervention among patients with or at high risk for coronary heart disease and their partners.

Hypothesis:

A nurse-led approach to lifestyle intervention will be more effective.

Study Design

  • Randomized

Patients Enrolled: 8,657
Mean Follow Up: 1 year

Patient Populations:

Acute coronary syndrome or stable coronary artery disease (coronary disease cohort) or at high risk for coronary artery disease or treated for hypertension of diabetes (high-risk cohort)

Exclusions:

• Severe heart failure
• Severe physical disability
• Dementia

Primary Endpoints:

Goals:
• No smoking
• Saturated fat <10% of total dietary energy per day, fruit and vegetables >400 g per day, fish >20 g per day, oily fish >3 times per week, and alcohol <30 g per day
• Body mass index <25 kg/m2, waist circumference <80 cm for women and <94 cm for men
• Physical activity: 30-45 minutes of moderate intensity physical activity 4-5 times per week
• Blood pressure <140/90 mm Hg (<130/85 mm Hg for diabetics)
• Total cholesterol <5 mmol/L, low-density lipoprotein cholesterol <3 mmol/L
• Blood glucose concentration <6.1 mmol/L, glycated hemoglobin <7% for diabetics
• Cardioprotective medications prescribed as clinically indicated; antiplatelet medications, beta-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering medications

Drug/Procedures Used:

Hospitals and general practices in eight countries were randomized to usual care (n = 2,613 patients and 1,634 partners) or EuroAction intervention program (n = 2,778 patients and 1,632 partners). In the intervention group, a nurse-led intervention team sought to improve lifestyle, risk factors, and therapeutic management. Lifestyle and risk factors addressed included diet, physical activity, central obesity, blood pressure, cholesterol, and glucose.

Concomitant Medications:

At the initial patient assessment, the use of antiplatelet drugs (for hospital coronary patients receiving intensive nursing intervention vs. hospital coronary patients receiving usual care) was 94% versus 95%, beta-blockers was 78% versus 85%, angiotensin-converting enzyme inhibitors was 55% versus 47%, and statins was 79% versus 79%.

Principal Findings:

More patients in the intervention group met recommended fruit and vegetable intake guidelines (coronary disease cohort: 72% with intervention vs. 35% for usual care; high-risk cohort: 78% vs. 39%). Likewise, partners of those in the intervention group also more frequently met recommended fruit and vegetable intake guidelines (coronary disease cohort partners: 72% with intervention vs. 37% for usual care; high-risk cohort: 77% vs. 54%). Consumption of saturated fat to <10% of caloric intake was also reduced with the intervention group (coronary disease cohort: 55% with intervention vs. 40% for usual care) and consumption of oily fish was increased (≥3 times per week, coronary disease cohort: 17% with intervention vs. 8% for usual care).

Physical activity targets of exercise 30-45 minutes 4-5 times per week were met more frequently in the intervention group (coronary disease cohort: 54% with intervention vs. 20% for usual care; high-risk cohort: 50% vs. 22%) and partners of the intervention group (coronary disease cohort: 41% with intervention vs. 27% for usual care; high-risk cohort: 44% vs. 25%).

Blood pressure targets were more frequently met in the intervention group in both diabetic and nondiabetic patients. In the coronary disease cohort, total cholesterol targets of <5 mmol/L were similar in the intervention group (78%) and for the usual care group (71%). Cardiac medication use was higher in the intervention group compared with the usual care group. Among those who were smokers at the time of the coronary event, 58% of those in the intervention group stopped smoking versus 47% for usual care.

Interpretation:

Among patients with or at high risk for coronary heart disease and their partners, use of a nurse-led prevention intervention program was associated with improvements in lifestyle modifications compared with usual care.

The present trial is one of the first large-scale behavior modification/risk reduction studies to target not only coronary disease patients, but also the partners of these patients. Additional analysis is underway to further evaluate the cost and cost-effectiveness of the program.

References:

Wood DA, Kotsevak K, Connolly S, et al. 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. Lancet 2008;371:1999-2012.

Presented by D.A. Wood, European Society of Cardiology Scientific Congress, September 2006.

Clinical Topics: Acute Coronary Syndromes, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Hypertension, Smoking

Keywords: Obesity, Abdominal, Life Style, Behavior Therapy, Acute Coronary Syndrome, Risk Reduction Behavior, Risk Factors, Smoking, Glucose, Cholesterol, Fruit, General Practice, Vegetables, Motor Activity, Energy Intake, Hypertension, Diabetes Mellitus


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