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 .
Effects of an enhanced secondary prevention program for patients with heart disease: a prospective randomized trial.
BACKGROUND Secondary prevention medications in cardiac patients improve outcomes . However , prescription rates for these drugs and long-term adherence are suboptimal . OBJECTIVE To determine whether an enhanced secondary prevention program improves outcomes . METHODS Hospitalized patients with indications for secondary prevention medications were r and omly assigned to either usual care or an intervention arm , in which an intensive program was used to optimize prescription rates and long-term adherence . Follow-up was 19 months . RESULTS A total of 2643 patients were r and omly assigned in the study ; 1342 patients were assigned to usual care and 1301 patients were assigned to the intervention arm .  Prescription rates were near optimal except for lipid-lowering medications . Rehospitalization rates per 100 patients were 136.2 and 132.6 over 19 months in the usual care and intervention groups , respectively ( P=0.59 ) . Total days in hospital per patient were similar ( 10.9 days in the usual care group versus 10.2 days in the intervention group ; P not significant ) . Crude mortality was 6.2 % and 5.5 % in the usual care and intervention groups , respectively , with no significant difference ( P=0.15 ) in overall survival . Post hoc analysis suggested that after the study team became experienced , days in hospital per patient were reduced by the program ( 11.1+/-0.91 and 8.9+/-0.61 in the usual care and intervention groups , respectively ; P<0.05 ) . CONCLUSIONS The intervention program failed to improve outcomes in the present study . One explanation for these results is the near optimal physician compliance with guidelines in both groups . It is also possible that a substantial learning curve for the staff was involved , as suggested by the reduction in total days in hospital in the intervention patients during the second part of the study
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 .