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 .
Clinical trial of an educational intervention to achieve recommended cholesterol levels in patients with coronary artery disease.
BACKGROUND Despite national efforts to improve cholesterol management for patients with coronary artery disease , many patients are not reaching recommended cholesterol target levels . We sought to determine whether a nurse-based educational intervention , design ed to educate patients with confirmed coronary artery disease about personal low-density lipoprotein ( LDL ) cholesterol target levels and encourage partnership with physicians , could increase adherence with National Cholesterol Education Program target levels ( LDL cholesterol level < or = 100 mg/dL ) . METHODS Patients hospitalized with confirmed coronary artery disease were r and omized to undergo a  nurse-based educational intervention ( 375 patients ) or usual care ( 381 patients ) for a 12-month period after hospitalization . The primary outcome was the proportion of patients at the LDL cholesterol target level 1 year after hospitalization . The secondary outcome was the proportion of patients with accurate knowledge of LDL cholesterol target levels . RESULTS The groups were similar at baseline in demographic and clinical characteristics , percent at LDL cholesterol target level ( 43.9 % and 41.1 % , respectively ) , and percent with knowledge of LDL cholesterol target levels ( both 5 % ) . The proportion of patients at LDL cholesterol target levels at 1 year did not differ between the intervention ( 70.2 % ) and usual care group ( 67.4 % , P = .46 ) . At the conclusion of the trial , patient knowledge about LDL cholesterol target level was higher for the intervention group than the usual care group ( 19.6 % and 6.7 % , respectively , P = .001 ) , but this was not associated with improved cholesterol management . CONCLUSIONS Our nurse-based educational intervention did not result in a significant increase in the proportion of patients who reached target LDL cholesterol levels 1 year after hospitalization . Although the intervention improved patient knowledge of LDL cholesterol target levels , overall rates of LDL cholesterol knowledge remained low , and it was not associated with improved cholesterol management
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 .