Multifactorial lifestyle interventions aim ed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events .
Therefore , they may have added value in secondary prevention of CHD
CONTEXT Coronary heart disease ( CHD ) is responsible for about 15 % of all deaths worldwide and is identified as a top priority for decision makers .
Both primary and secondary prevention are considered key strategies in the prevention of CHD .
The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care .
Prolonged effects of a home-based intervention in patients with chronic illness.
BACKGROUND Data on the long-term benefits of nonspecific disease management programs are limited . We performed a long-term follow-up of a previously published r and omized trial . METHODS We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary , home-based intervention ( HBI ) ( n = 260 ) or to usual postdischarge care ( n = 268 ) . RESULTS During follow-up , HBI had no impact on all-cause mortality ( relative risk , 1.04 ; 95 % confidence interval , 0.80 - 1.35 ) or event-free survival from death or unplanned hospitalization ( relative risk , 1.03 ; 95 % confidence interval , 0.86 - 1.24 ) . Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization , with 677 readmissions vs 824 for the usual care group ( mean + /- SD rate , 0.72 + /- 0.96 vs 0.84 + /- 1.20 readmissions/patient per year ; P = .08 ) . When accounting for increased hospital activity in  HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years , post hoc analyses showed that HBI reduced readmissions by 14 % within 2 years in patients without this condition ( mean + /- SD rate , 0.54 + /- 0.72 vs 0.63 + /- 0.88 readmission/patient per year ; P = .04 ) and by 21 % in all surviving patients within 3 to 8 years ( mean + /- SD rate , 0.64 + /- 1.26 vs 0.81 + /- 1.61 readmissions/patient per year ; P = .03 ) . Overall , recurrent hospital costs were significantly lower ( 14 % ) in the HBI group ( mean + /- SD , 823 dollars + /- 1642 dollars vs 960 dollars + /- 1376 dollars per patient per year ; P = .045 ) . CONCLUSION This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses , except for chronic obstructive pulmonary disease
Multifactorial lifestyle interventions aim ed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events .
Therefore , they may have added value in secondary prevention of CHD
CONTEXT Coronary heart disease ( CHD ) is responsible for about 15 % of all deaths worldwide and is identified as a top priority for decision makers .
Both primary and secondary prevention are considered key strategies in the prevention of CHD .
The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care .