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 .
[Intensified after-care--a method for improving occupational reintegration after myocardial infarct and/or bypass operation].
Occupational reintegration after coronary heart disease of patients who are insured by the German workers pension ( Arbeiterrentenversicherung ) succeeds in 40 - 60 % of the recorded cases . Patients who were not able to return to work after finishing their regular cardiac rehabilitation took part in a program called " Intensivierte Nachsorge ( INA ) " . INA is an interdisciplinary support program , taking place twice a week for a whole day over a period of six weeks . On the remaining three days patients were either progressively reintegrated into their working place or stayed at home . The results of the INA group were compared to those of a control group . Two years after patients had terminated the cardiac rehabilitation , statistically significant effects could still be found : 70.2 % of the INA group had returned to work compared to 52.6 % of the control group . This is a difference of 17.6 % . After the results had been corrected by considering age differences between the two groups , the control group had a recalculated return to work rate of 57.4 % . A significant difference of 12.8 % could still be identified with respect to the INA group . Support programs which follow regular cardiac rehabilitation seem to be specially suitable for older patients with highly perceived job strain , because our results showed that these patients had lower return to work rates . 44.2 % of the INA group and 21.9 % of the control group were progressively reintegrated into their work place . Two years after their regular rehabilitation 36.3 % of the INA group patients took part in ambulatory heart groups compared with 10.4 % of the control group . It was also found that patients of the INA group showed improvements in activities of daily life . The INA program however does not seem to have an influence on behavioral components such as eating habits , relaxation , and smoking as well as on the psychological status . The physical fitness measured in watt x min at the beginning of the INA program ( T1 ) was 589.46 + /- 255.03 in the control group . This number increased to 598.32 + /- 276.01 six months after regular rehabilitation ( T3 ) and continued to rise to 661.15 + /- 362.01 after two years ( T4 ) . In the INA group the numbers were as follows : 658.13 + /- 263.63 at T1 , 751.83 + /- 318.15 at T3 , and 717.93 + /- 336.76 at T4 . The differences between the groups are significant at T1 and T3 , whereas at T4 there is no significant difference . It should also be stated that the lipid parameters indicated no differences between the groups except for the triglyceride values which were significantly lower statistically in the INA group than in the control group
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 .