The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes .
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 .
Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care.
BACKGROUND The long-term effects of disease management programmes for coronary heart disease on health status are unknown . In a r and omized trial of nurse-led secondary prevention clinics , we found significantly improved health status at 1 year . Participants were followed-up again at 4 years to determine if improvements had been sustained . OBJECTIVE Our aim was to evaluate the effects on health of  nurse-led clinics for the secondary prevention of coronary heart disease in primary care . METHODS A total of 1343 patients with coronary heart disease were r and omized to nurse-led secondary prevention clinics or usual care  , with follow-up at 1 and 4 years by review of medical case notes and national data sets , and postal question naires . The study involved a stratified , r and om sample of 19 general practice s in north-east Scotl and .  Health status was measured by the SF-36 question naire , chest pain by the angina TyPE specification and anxiety and depression by the hospital anxiety and depression scale . RESULTS At 1 year , there were significant improvements in five of eight SF-36 domains ( all functioning scales , pain and general health ) in patients r and omized to clinics . Role limitations attributed to physical problems improved the most [ adjusted difference 8.52 , 95 % confidence interval ( CI ) 4.16 - 12.9 ] . At 4 years , the intervention group scored higher than control in all domains , but differences were no longer significant . At 1 year , fewer patients in the intervention group reported worsening chest pain ( odds ratio 0.59 , 95 % C1 0.37 - 0.94 ) . At 4 years , there were no significant differences between the proportion of intervention or control group patients who reported chest pain in the last week or who reported worsening chest pain . No significant effects were observed on anxiety or depression at 1 or 4 years . CONCLUSION We have demonstrated previously a significantly greater survival in attendees at nurse-led secondary prevention clinics . Despite this , improvements in health status achieved in the first year of the study were reduced at 4 years . The case for nurse-led clinics remains strong , but further research is required on ways to optimize current health status
The overall results for modifiable risk factors suggested improvements in dietary and exercise outcomes but no overall effect on smoking outcomes .
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 .