Nurse-Coordinated Multidisciplinary, Family-Based Cardiovascular Disease Prevention Programme - EUROACTION
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.
A nurse-led approach to lifestyle intervention will be more effective.
Patients Enrolled: 8,657
Mean Follow Up: 1 year
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)
• Severe heart failure
• Severe physical disability
• 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
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.
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%.
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.
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.
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.
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
< Back to Listings