Comparing the effectiveness of two cardiovascular prevention programmes for highly educated professionals in general practice: a randomised clinical trial The Sydney Diabetes Prevention Program: A community-based translational study Selection bias in enrollment to a programme aimed at the secondary prevention of ischaemic heart disease in general practice: a cohort study. A British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events). Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Systematic Review of the Effect of Diet and Exercise Lifestyle Interventions in the Secondary Prevention of Coronary Heart Disease A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: baseline results Inter99 (1) Psychosocial distress and impaired quality of life - targets neglected in the secondary prevention in women with ischaemic heart disease A randomized controlled trial of an extensive lifestyle management intervention (ELMI) following cardiac rehabilitation: study design and baseline data A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway – a randomized controlled trial No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial. Skinfold thickness, body mass index and ischaemic heart disease. The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six months after discharge following an episode of acute coronary syndrome, (CAM-2 Project): a randomized controlled trial Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease Primary prevention of coronary heart disease versus health promotion--a contradiction? The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411] Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care Risk factors for sudden cardiac death in middle-aged British men. The effects of Hartcoach, a life style intervention provided by telephone on the reduction of coronary risk factors: a randomised trial Individualised multifactorial lifestyle intervention trial for high-risk cardiovascular patients in primary care.
Background Cardiovascular disease is a major cause of mortality and morbidity and its prevalence is set to increase . While the benefits of medical and lifestyle interventions are established , the effectiveness of interventions which seek to improve the way preventive care is delivered in general practice is less so . The aim was to study and to compare the effectiveness of 2 intervention programmes for reducing cardiovascular risk factors within general practice . Methods A r and omised controlled trial was conducted in Belgium between 2007 - 2010 with 314 highly educated and mainly healthy professionals allocated to a medical ( MP ) or a medical + lifestyle ( MLP ) programme . The MP consisted of medical assessment s ( screening and follow-up ) and the MLP added a tailored lifestyle change programme ( web-based and individual coaching ) to the MP . Primary outcomes were total cholesterol , blood pressure , and body mass index ( BMI ) . The secondary outcomes were smoking status , fitness-score , and total cardiovascular risk . Results The mean age was 41 years , 95 ( 32 % ) participants were female , 7 had a personal cardiovascular event in their medical history and 3 had diabetes . There were no significant differences found between MP and MLP in primary or secondary outcomes . In both study conditions decreases of cholesterol , systolic blood pressure , and diastolic blood pressure were found . Unfavourable increases were found for BMI ( p < .05 ) . A significant decrease of the overall cardiovascular risk was reported ( p < .001 ) . Conclusions Both interventions are effective in reducing cardiovascular risk . In our population the combined medical and lifestyle programme was not superior to the medical programme . Trial registration IS RCT Background Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity . Prevention is an essential component of strategies to reduce the diabetes burden . There is strong and consistent evidence from r and omised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet , increases physical activity and achieves weight loss in at risk people . The current challenge is to translate this evidence into routine community setting s , determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes . Methods / Design The Sydney Diabetes Prevention Program ( SDPP ) is a translational study which will be conducted in 1,550 participants aged 50 - 65 years ( including 100 indigenous people aged 18 years and older ) at high risk of future development of diabetes . Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention . The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals : 5 % weight loss , 210 min/week physical activity ( aerobic and strength training exercise ) , limit dietary fat and saturated fat to less than 30 % and 10 % of energy intake respectively , and at least 15 g/1000 kcal dietary fibre . This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months . The effectiveness and costs of the program on diabetes-related risk factors will be evaluated . Main outcomes include changes in weight , physical activity , and dietary changes ( fat , saturated fat and fibre intake ) . Secondary outcomes include changes in waist circumference , fasting plasma glucose , blood pressure , lipids , quality of life , psychological well being , medication use and health service utilization . Discussion This translational study will ascertain the reach , feasibility , effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care . If demonstrated to be effective , it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people OBJECTIVE To evaluate differences between adults who participated in a secondary prevention of ischaemic heart disease ( IHD ) programme and those who did not . DESIGN Population -based cohort study . SETTING A r and om selection of 12 Irish general practice s. PARTICIPANTS A total of 493 adults with IHD identified in 2000/2001 . INTERVENTION Medical records search and postal question naires in 2000/2001 and 2005/2006 . MAIN OUTCOME MEASURES Differences in demographic characteristics and indicators of process of care and risk factor management between participants and non- participants . RESULTS Multiple logistic regression confirmed that female gender was associated with a reduced likelihood of participation in the secondary prevention programme [ odds ratio ( OR ) 0.53 ( 95 % CI : 0.32 - 0.87 ) ] , while an adequately controlled total cholesterol level was associated with an increased likelihood of enrollment [ OR 1.82 ( 95 % CI : 1.18 - 2.80 ) ] . CONCLUSIONS There is limited evidence that biases , which have been shown to affect participation in research , also affect participation in care programmes in everyday practice . A gender bias appears to have affected the enrollment of participants for the secondary preventive programme considered by this study , with enrollment favouring men with well-managed cholesterol . Reimbursement dependent upon patient adherence may incentivise the enrollment of adherent patients , although the influence of patient choice is unclear : the need to maintain records relating to patients who opt out of such interventions is thus highlighted OBJECTIVE : To measure the potential for secondary prevention of coronary disease in the United Kingdom . DESIGN : Cross sectional survey of a representative sample of coronary patients from a retrospective review of hospital medical records and patient interview and examination . SETTING : Stratified r and om sample of 12 specialist cardiac centres and 12 district general hospitals drawn from 34 specialist cardiac centres and 261 district general hospitals in 12 geographic areas in the United Kingdom . SUBJECTS : 2583 patients < or = 70 yr ; 25 consecutive males and 25 consecutive females identified retrospectively in each of four diagnostic categories : coronary artery bypass grafting , percutaneous transluminal coronary angioplasty , acute myocardial infa rct ion , and acute myocardial ischaemia without evidence of infa rct ion . MAIN OUTCOME MEASURES : Risk factor recording and management in medical records ; the prevalence and control of risk factors at interview six months after the procedure or event . RESULTS : Recording of coronary risk factors in patient 's records was incomplete and this varied by risk factor . Smoking habit and blood pressure were most completely recorded , whereas a history of hyperlipidaemia and blood cholesterol concentrations were least complete . Risk factor records were more likely to be complete in cardiac centres than in district hospitals . At interview 10 % to 27 % of patients were still smoking cigarettes and 75 % remained overweight , females more severely so . Up to a quarter of patients remained hypertensive , males more severely so than females . Over three quarters had a total cholesterol > 5.2 mmol/l . In patients on medication for blood pressure , cholesterol or glucose , risk factor profiles were little better than in those who were not . Only about one patient in three was taking a beta blocker after infa rct ion . Up to a fifth of patients who had had acute myocardial ischaemia were not taking aspirin at follow up . CONCLUSIONS : There is considerable potential to reduce the risk of a further major ischaemic event in patients with established coronary disease . This can be achieved by effective lifestyle intervention , the rigorous management of blood pressure and cholesterol , and the appropriate use of prophylactic drugs Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 The effectiveness of lifestyle interventions within secondary prevention of coronary heart disease ( CHD ) remains unclear . This systematic review aim ed to determine their effectiveness and included r and omized controlled trials of lifestyle interventions , in primary care or community setting s , with a minimum follow-up of three months , published since 1990 . 21 trials with 10,799 patients were included ; the interventions were multifactorial ( 10 ) , educational ( 4 ) , psychological ( 3 ) , dietary ( 1 ) , organisational ( 2 ) , and exercise ( 1 ) . The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes . In trials that examined mortality and morbidity , significant benefits were reported for total mortality ( in 4 of 6 trials ; overall risk ratio ( RR ) 0.75 ( 95 % confidence intervals ( CI ) 0.65 , 0.87 ) ) , cardiovascular mortality ( 3 of 8 trials ; overall RR 0.63 ( 95 % CI 0.47 , 0.84 ) ) , and nonfatal cardiac events ( 5 of 9 trials ; overall RR 0.68 ( 95 % CI 0.55 , 0.84 ) ) . The heterogeneity between trials and generally poor quality of trials make any concrete conclusions difficult . However , the beneficial effects observed in this review are encouraging and should stimulate further research Background Various strategies have been used to induce lifestyle changes to reduce ischaemic heart disease ( IHD ) with various successes . The aim of Inter99 is to assess the effect on IHD incidence of individually tailored non-pharmacological intervention on lifestyle using a newly developed computer-based health educational tool . The article describes the study and baseline results . Methods From a population of 61,301 individuals two r and om sample s ( high intensity intervention group ( A ) , n = 11,708 ; low intensity intervention group ( B ) , n = 1308 ) are screened to assess their absolute risk of IHD . Those at high risk receive individual lifestyle counselling . Individuals in group A are furthermore offered lifestyle counselling in groups on smoking cessation or physical activity/diet over a 6-month period . Individuals in group B are referred to their GP . High-risk persons are re-counselled after 1 and 3 years and the whole group is re-invited after 5 years . The remaining 48,285 ( group C ) are followed by question naire . The total population is followed through central registers . Intermediate end-points are changes in lifestyle , cholesterol , blood pressure and body mass index . Final end-point is reduction in incidence of IHD . Results The r and omization leads to comparable groups . Participation rate was 52.5 % . A total of 60 % fulfilled the predetermined criteria for being at high risk for developing IHD . After an individual lifestyle counselling 41 % accepted group-based counselling . Conclusion This large r and omized population based trial discloses a noticeable need for and acceptance of lifestyle intervention in the general population . Eur J Cardiovasc Prevention Rehab 10:377 - 386 © 2003 Lippincott Williams & Wilkins Background Secondary prevention in patients with ischaemic heart disease ( IHD ) focusing on classical risk factors has been less successful in women than in men . Previous studies have suggested that psychosocial factors may be new targets for secondary prevention . In the present study , psychosocial factors have been compared in women with and without IHD . Methods and subjects Using a cross-sectional comparison , classical cardiovascular risk factors and self-rated stress behaviour , vital exhaustion , stressful life events and quality of life  were assessed in 198 women ( age 35–77 years ) who had IHD and a population -based sample of 206 women ( age 45–74 years ) without IHD . Results Control of classical risk factors was most often adequate in women with IHD . The prevalence of smoking was 9 % in women with versus 18 % in women without IHD ( P < 0.001 ) , blood pressure levels were similar , and a very large share of women with IHD were on treatment with anti-thrombotic , anti-hypertensive and /or lipid-lowering drugs ( P < 0.001 compared with women free of IHD ) . In contrast , women with IHD scored significantly worse than women without IHD in self-rated stress behaviour ( P = 0.003 after adjustment for other possible determinants ) , and in vital exhaustion ( P = 0.003 ) . In univariate analyses , quality of life was significantly worse in women with IHD . Stressful life events did not differ between the two groups . Conclusions In this group of women with IHD , control of classical risk factors was good , whereas control of psychosocial risk factors was clearly inadequate . Secondary prevention by psychosocial intervention in women with IHD should be evaluated in r and omized controlled trials . Eur J Cardiovasc Prevention Rehab 10:258–266 © 2003 Lippincott Williams & Wilkins Background Cardiac rehabilitation programs ( CRP ) represent comprehensive interventions that are typically limited to four months . Following completion of CRP , it appears that risk factors and lifestyle behaviours may deteriorate . The Extensive Lifestyle Management Intervention ( ELMI ) Following Cardiac Rehabilitation trial will investigate the benefits of a r and omized intervention to prevent these adverse changes . Methods Patients with ischemic heart disease ( IHD ) were r and omized following a st and ard CRP to the ELMI or to usual care .  The ELMI program is a case-managed intervention aim ed at individualizing risk factor and lifestyle management based on current treatment guidelines . The program consists of cardiac rehabilitation sessions , telephone follow-up and risk factor and lifestyle counselling sessions . Health professionals work with participants using behavioural counselling and communications with participants ' family physicians . Usual care participants return to their family physicians ' care , and come to the study clinic only to undergo annual outcomes assessment . The primary outcome is change in IHD global risk after four years . Secondary outcomes include combined cardiovascular events , health care utilization , lifestyle adherence , quality of life and risk factors . Results Over 28 months , 302 men and women were r and omized . This represented 29 % of the total population screened . The average age of study participants is 64 years , 18 % are women , 53 % have had a previous myocardial infa rct ion , 73 % have undergone previous revascularization and 20 % have diabetes mellitus .  Ischemic heart disease risk factors for the entire cohort improved significantly after subjects had gone through previous CRPs . Baseline risk factors , lifestyle behaviours and medications were similar between the groups . Conclusions This study population is representative of patients completing a st and ard CRP  . Results of the ELMI trial will provide valuable information for the future design of CRPs Objectives : The aim of the study was twofold ; 1 ) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease ( CHD ) discharged from the University Hospital of North Norway , and 2 ) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors . Methods : A total of 102 patients aged 18 - 82 years were enrolled in a non-blinded r and omized controlled trial with an intervention group and a control group . The intervention comprised medication reconciliation , medication review and patient education during three meetings ; at discharge , after three months and after twelve months . The control group received st and ard care from their general practitioner . Primary outcomes were adherence to clinical guideline recommendations concerning prescription , therapy goal achievement and lifestyle education  defined in the medication assessment tool for secondary prevention of CHD ( MAT-CHDSP ) . Secondary outcomes included changes in the biomedical risk factors cholesterol , blood pressure and blood glucose . Results : Ninety-four patients completed the trial , 48 intervention group patients and 46 controls . Appropriate prescribing was high , but therapy goal achievement was low in both groups . Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end , 78.4 % vs. 62.0 % , p<0.001 . The difference was statistically significant for the documented lifestyle advices in intervention group patients . No significant improvements in biomedical risk factors were observed in favor of the intervention group . Conclusions : The study showed an increased guideline adherence in both study groups . This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task . A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention . Amendments to the follow-up program are suggested before implementation in st and ard patient care can be recommended Summary Impaired glucose tolerance ( IGT ) is associated with increased mortality due to ischaemic heart disease ( IHD ) , but as it is not known whether this excess mortality can be reduced by preventing or delaying the development of non-insulin-dependent diabetes mellitus ( NIDDM ) , a long-term NIDDM prevention trial of dietary counselling and physical exercise was launched at Malmö , Sweden , the 12-year follow-up of which is reported here . At 12-year follow-up of 6956 men who underwent health screening at 48 years of age , an IGT intervention group ( n = 288 ) who participated in a long-term NIDDM prevention programme were compared with an IGT non-r and omised routine treatment group ( n = 135 ) , a diabetic group ( n = 144 ) , and the remainder , the normal glucose tolerance ( NGT ) group ( n = 6389 ) . The variables studied included the levels of blood glucose , plasma insulin , blood pressure , blood lipids , lung function and maximum oxygen uptake .  Subjects with IGT were characterised by overweight , poor vital capacity , hypertension , hypertriglyceridaemia and hyperinsulinaemia . The mortality rate in the IGT intervention group was similar to that in the NGT group ( 6.5 vs 6.2 per 1000 person years at risk ) and lower than that in the IGT routine treatment group ( 6.5 vs 14.0 , p = 0.009 ) . In the two IGT groups taken together , intervention but not body mass index , systolic blood pressure , smoking , cholesterol or the 2-h glucose level predicted mortality . Systolic blood pressure was a predictor of IHD mortality among IGT subjects ; and in the cohort as a whole , body mass index , systolic blood pressure , hypercholesterolaemica , diabetes and smoking were predictors of IHD mortality . The findings suggest that a long-term intervention programme , with an emphasis on lifestyle changes , including dietary counselling and physical exercise , will reduce mortality in subjects with IGT who are at an increased risk of both developing NIDDM and of premature death due to IHD and other causes . [ Diabetologia ( 1998 ) 41 : 1010–1016 Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease , providing access to such interventions is a major challenge . This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk . Methods and analysis R and omised controlled trial with 6 months of follow-up to evaluate the feasibility , acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care .  A total of 720 patients with coronary artery disease will be r and omised to either st and ard care or the TEXT ME intervention . The intervention group will receive multiple weekly text messages that provide information , motivation , support to quit smoking ( if relevant ) and recommendations for healthy diets and exercise . The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months . Secondary end points include a change in systolic blood pressure , smoking status , quality of life , medication adherence , waist circumference , physical activity levels , nutritional status and mood at 6 months . Process outcomes related to acceptability and feasibility of TEXT ME will also be collected . Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee — Westmead . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences . Clinical trials registration number ACTRN12611000161921 IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921 STUDY OBJECTIVE : To determine the relationship between obesity and subsequent incidence of ischaemic heart disease ( IHD ) .  DESIGN : Prospect i ve cohort survey . SETTING : Study of three occupational groups , with follow up examinations . SUBJECTS : 3500 people recruited between 1972 and 1978 ( 80 % response rate ) , and followed up between 1978 and 1984 . This report is based on subgroup of 1511 white men aged 40 - 64 at entry . MEASUREMENTS AND MAIN RESULTS : Information was obtained on smoking and family history of IHD . Blood pressure , weight , height , skinfold thickness at four sites , fibrinogen , factor VII activity and cholesterol were measured during follow up . Body mass index ( BMI ) was used as an index of obesity . BMI was found to be more strongly correlated with IHD than any of the skinfold measurements , none of which was significantly associated with IHD when BMI was allowed for . Increase in BMI by 1 SD ( approximately 8 kg ) was associated with a 44 % increase in the risk of IHD . Of the four skinfolds , subscapular was the most closely associated with risk , confirming the relevance of central obesity . The association between obesity and IHD remained when possible mechanisms for its effects were taken into account , and its strength may increase with time : for 1 SD increase in BMI , risk of events within 5 years was increased by 28 % , while risk of events after longer than 5 years was increased by 65 % . CONCLUSIONS : Preventive strategies for IHD should include avoidance of obesity Objectives We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached , improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome . Background There is room to improve mid-term adherence to clinical guidelines ' recommendations in coronary heart disease secondary prevention , specially non-pharmacological ones , often neglected . Methods In CAM-2 , patients discharged after an acute coronary syndrome were r and omly assigned to the intervention or the usual care group . The primary outcome was reaching therapeutic objectives in various secondary prevention variables : smoking , obesity , blood lipids , blood pressure control , exercise and taking of medication . Results 1757 patients were recruited in 64 hospitals and 1510 ( 762 in the intervention and 748 in the control group ) attended the six-months follow-up visit . After adjustment for potentially important variables , there were , between the intervention and control group , differences in the mean reduction of body mass index ( 0.5 vs. 0.2 ; p < 0.001 ) and waist circumference ( 1.6 cm vs. 0.6 cm ; p = 0.05 ) , proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl ( 64.7 % vs. 56.5 % ; p = 0.001 ) . The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins ( 98.1 % vs. 95.9 % ; p = 0.029 ) . Conclusions At least in the short term , lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males The German Cardiovascular Prevention Study is a multicentre community-based intervention study with the primary goal of reducing cardiovascular mortality by primary prevention measures . The intervention strategy comprises improving people 's life styles as well as health promotion so as to modify cardiovascular risk factors ( hypercholesterolemia , cigarette smoking , arterial hypertension , physical inactivity and over-weight ) . Design elements of the German Cardiovascular Prevention Study , now in its fifth year , were adopted from well known community intervention studies , including monitoring of mortality and morbidity , health examination surveys to assess distribution of cardiovascular risk factors , health attitudes and health behaviour in the community and use of formative and process evaluation to monitor the effects of intervention policies in the community . To identify risk factor profiles a cluster analysis was carried out from survey data . Four clusters were identified : a ) people with none or few risk factors ; b ) those with high prevalence of smoking ; c ) those with high prevalence of hypercholesterolemia and hypertension ; d ) high risk factor exposure individuals . The clusters are different along social indicators like age , sex and social status . Process evaluation data show that special strategies like interventive blood pressure screenings reached a relatively high proportion of people from lower socioeconomic status . But they also indicate that there is a long way to go from publicity of intervention programs to lasting changes in behaviour Background The aim of the SPHERE study is to design , implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease ( CHD ) in general practice across two different health systems on the isl and of Irel and .CHD is a common cause of death and a significant cause of morbidity in Irel and . Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives . Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the isl and of Irel and . The review literature recommends structured programmes with continued support and follow-up of patients ; the provision of training , tailored to practice needs of access to evidence of effectiveness of secondary prevention ; structured recall programmes that also take account of individual practice needs ; and patient-centred consultations accompanied by attention to disease management guidelines . Methods SPHERE is a cluster r and omised controlled trial , with practice -level r and omisation to intervention and control groups , recruiting 960 patients from 48 practice s in three study centres ( Belfast , Dublin and Galway ) . Primary outcomes are blood pressure , total cholesterol , physical and mental health status ( SF-12 ) and hospital re-admissions . The intervention takes place over two years and data is collected at baseline , one-year and two-year follow-up . Data is obtained from medical charts , consultations with practitioners , and patient postal question naires . The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice . It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients . General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD . Patients are invited to attend regular four-monthly consultations over two years , during which targets and goals for secondary prevention are set and review ed . The analysis will be strengthened by economic , policy and qualitative components AIMS AND OBJECTIVES To evaluate the one-year prognosis of a lifestyle counselling intervention ( diet , smoking cessation and exercise ) among patients who had open heart surgery . BACKGROUND Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries . Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease . DESIGN R and omised , nonblind and lifestyle counselling intervention study with a one-year follow-up . METHODS A r and omised , nonblind intervention study was performed on 500 patients who had open heart surgery . After hospital discharge , 250 patients ( intervention group ) were r and omly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology ( European Journal Preventive Cardiology , 19 , 2012 , 585 ) . The remaining 250 patients ( control group ) received the regular instructions . Primary end-point was the development of a cardiovascular disease ( nonfatal event ) during the first year ; secondary end-points included fatal events , smoking abstinence , dietary habits and a physical activity evaluation . RESULTS According to the primary end-point , the odds of having a nonfatal cardiovascular disease event are 0·56-times ( 95%CI 0·28 , 0·96 , p = 0·03 ) lower for the intervention group compared to the control group . One-year after surgery , it was found that participants in the intervention group were 1·96-times ( 95%CI 1·31 , 2·93 , p < 0·001 ) more likely to achieve dietary recommendations , 3·32-times ( 95%CI 2·24 , 4·91 , p < 0·001 ) more likely to achieve physical activity recommendations and 1·34-times ( 95%CI 1·15 , 1·56 , p < 0·001 ) more likely to return to work . CONCLUSION Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event . Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient 's needs . RELEVANCE TO CLINICAL PRACTICE A well-structured cardiac rehabilitation programme adjusted to the patient 's profile is a safe and cost-effective way to improve patients ' outcome Abstract Objectives : To evaluate the effects of nurse led clinics in primary care on secondary prevention , total mortality , and coronary event rates after four years . Design : Follow up of a r and omised controlled trial by postal question naires and review of case notes and national data sets . Setting : Stratified , r and om sample of 19 general practice s in north east Scotl and . Participants : 1343 patients ( 673 intervention and 670 control ) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound . Intervention : Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year . Main outcome measures : Components of secondary prevention ( aspirin , blood pressure management , lipid management , healthy diet , exercise , non-smoking ) , total mortality , and coronary events ( non-fatal myocardial infa rct ions and coronary deaths ) . Results : Mean follow up was at 4.7 years . Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year , and these were sustained after four years except for exercise . The control group , most of whom attended clinics after the initial year , caught up before final follow up , and differences between groups were no longer significant . At 4.7 years , 100 patients in the intervention group and 128 in the control group had died : cumulative death rates were 14.5 % and 18.9 % , respectively ( P=0.038 ) . 100 coronary events occurred in the intervention group and 125 in the control group : cumulative event rates were 14.2 % and 18.2 % , respectively ( P=0.052 ) . Adjusting for age , sex , general practice , and baseline secondary prevention , proportional hazard ratios were 0.75 for all deaths ( 95 % confidence intervals 0.58 to 0.98 ; P=0.036 ) and 0.76 for coronary events ( 0.58 to 1.00 ; P=0.049 ) Conclusions : Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events .  Secondary prevention clinics should be started sooner rather than later . What is already known on this topic Several effective interventions exist for the secondary prevention of coronary heart disease , but implementing them in practice has proved difficult Secondary prevention programmes for coronary heart disease have improved short term outcomes such as processes of care and quality of life What this study adds Short term improvements in uptake of secondary prevention produced by nurse led clinics are maintained in the longer term Improved medical and lifestyle components of secondary prevention produced by nurse led clinics seem to lead to fewer total deaths and coronary BACKGROUND Risk factors specific to sudden cardiac death ( SCD ) , ie , death within 1 hour after onset of symptoms , have been poorly identified , although recent findings from the present study incriminate heavy drinking and elevated heart rate . This paper examines the relations between a wide range of established and potential risk factors for ischemic heart disease ( IHD ) and SCD to identify independent risk factors for SCD and factors that might particularly or specifically relate to SCD . METHODS AND RESULTS We present a prospect i ve study of a cohort that was drawn from general practice s in 24 British towns of 7735 middle-aged men who were followed up for 8 years . During 8 years of follow-up , the men experienced 488 major IHD events ( nonfatal and fatal ) , of which 117 ( 24 % ) were classified as SCD . Age , preexisting IHD , arrhythmia , systolic blood pressure , blood cholesterol , elevated heart rate ( > or = 90 beats per minute ) , physical activity ( all , P < .05 ) , and , to a lesser extent , smoking ( P = .06 ) , HDL cholesterol ( P < .07 ) , and elevated hematocrit ( > or = 46 % , P < .09 ) emerged as independent risk factors for SCD after adjustment for a wide range of factors . Diabetes was not found to be associated with SCD , and forced expiratory volume in 1 second , body mass index , white blood cell count , and antihypertensive drugs were not associated with risk of SCD after adjustment . When examined in relation to non-sudden IHD deaths and nonfatal myocardial infa rct ion , elevated heart rate , heavy drinking , and arrhythmia emerged as factors that appear to be specific or particular to SCD . These three factors and age and blood cholesterol were associated with an increased risk of SCD in men both with and without preexisting IHD .  Physical activity , systolic blood pressure , and current smoking were associated with SCD only in men without preexisting IHD . HDL cholesterol and hematocrit were strong predictors of SCD only in men with preexisting IHD . CONCLUSIONS Three risk factors appear to be specific or particular to the risk of SCD , and these and other risk factors operate differently in patients with versus those without preexisting IHD . These findings have implication s for the causes and prevention of SCD Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Secondary prevention is essential , but participation rates for cardiac rehabilitation are low . Furthermore , current programmes do not accomplish that patients with CVD change their lifestyle in a way that their individual risk factors for recurrent events decrease , therefore more effective interventions are needed . In this study , the effectiveness of the Hartcoach-programme , a telephonic secondary prevention program focussing on self management , is studied . Methods / design A multicenter , r and omised parallel-group study is being conducted . Participants are 400 patients with acute myocardial infa rct ion ( STEMI , NSTEMI , ) and patients with chronic or unstable angina pectoris ( IAP ) . Patients are recruited through the participating hospitals and r and omly assigned to the experimental group ( Hartcoach-programme plus usual care ) or the control group ( usual care).The Hartcoach-programme consists of a period of six months during which the coach contacts the patient every four to six weeks by telephone . Coaches train patients to take responsibility for the achievement and maintenance of the defined target levels for their particular individual modifiable risk factors . Target levels and treatment goals are agreed by the nurse and patient together . Data collection is blinded and occurs at baseline and after 26 weeks ( post-intervention ) . Primary outcome is change in cardiovascular risk factors ( cholesterol , body mass index , waist circumference , blood pressure , physical activity and diet ) . Secondary outcomes include chances in glucose , HbA1c , medication adherence , self-management and quality of life . Discussion This study evaluates the effects of the Hartcoach-programme on the reduction of individual risk factors of patients with CVDs . Patients who are not invited to follow a hospital based rehabilitation programme or patients who are unable to adhere to such a programme , may be reached by this home based Hartcoach-programme . If positive results are found , the implementation of the Hartcoach-programme will be extended , having implication s for the management of many people with CVD.Trial registration BACKGROUND The multiprofessional teams in Finnish health centres are well placed to carry out interventions aim ed at the prevention of cardiovascular diseases . AIM To evaluate the effectiveness of an individually tailored multifactorial lifestyle intervention in primary care for individuals at high risk for cardiovascular disease . DESIGN OF STUDY A r and omised controlled trial was conducted over 24 months with interim assessment s at six and 12 months . SETTING A health centre in Finl and with a patient population of 11,000 . METHOD One hundred and fifty adults aged 18 to 65 years old with existing cardiovascular disease or multiple risk factors were r and omised to active multiprofessional risk factor intervention or to st and ard care . The main outcome measure was a change in cardiovascular risk-factor score . Secondary outcomes were changes in blood pressure , weight , body-mass index , serum cholesterol , blood glucose , smoking cessation , and exercise habits . RESULTS The cardiovascular risk score decreased by 28 % in the intervention group ( 23 % in the control group ) , body weight decreased by 3.7 % ( 2 % ) and total cholesterol decreased by 10.8 % ( 6.5 % ) , while time engaged in exercise increased by 39 % ( 43 % ) . Differences were not significant . CONCLUSIONS Cardiovascular risk levels of high-risk individuals decreased in both intervention and control groups . Primary care prevention should be targeted to high-risk persons . Long-term follow-up studies are needed
There were no significant effects of interventions on mean blood pressure or cholesterol levels , prescribing , smoking status or body mass index .
There was some suggestion of a " ceiling effect " whereby interventions have a diminishing beneficial effect once certain levels of risk factor management are reached .
There is weak evidence that regular planned recall of patients for appointments , structured monitoring of risk factors and prescribing , and education for patients can be effective in increasing the proportions of patients within target levels for cholesterol control and blood pressure .
BACKGROUND Ischaemic heart disease ( IHD ) is a major cause of mortality and morbidity and its prevalence is set to increase .
Secondary prevention aims to prevent subsequent acute events in people with established IHD .
While the benefits of individual medical and lifestyle interventions is established , the effectiveness of interventions which seek to improve the way secondary preventive care is delivered in primary care or community setting s is less so .
OBJECTIVES To assess the effectiveness of service organisation interventions , identifying which types and elements of service change are associated with most improvement in clinician and patient adherence to secondary prevention recommendations relating to risk factor levels and monitoring ( blood pressure , cholesterol and lifestyle factors such as diet , exercise , smoking and obesity ) and appropriate prophylactic medication .