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 .
A case-management program of medium intensity does not improve cardiovascular risk factor control in coronary artery disease patients: the Heartcare I trial.
BACKGROUND Case-management programs for secondary prevention of coronary artery disease that utilize extensive re sources can reduce cardiovascular risk factors , but less intensive approaches have failed to show benefits . This r and omized trial evaluated whether a medium intensity case-management program improves risk factor control in patients with coronary artery disease . METHODS We assigned 201 consecutive patients hospitalized for acute coronary events in the intensive care unit of University Hospital , Basel , Switzerl and , to either a risk factor case-management program ( n = 99 ) or care as usual ( n = 102 ) using the patients ' primary care physicians as the unit of r and omization ( cluster r and omization ) . The case-management program consisted of an hour of counseling by a clinician during hospitalization and two short reminders by phone and mail 3 and 6 months later . Treatment decisions were left to patients and their primary care physicians . RESULTS After 9 and 18 months of follow-up , there were no significant differences in lipid values , blood pressure control , fasting blood glucose , body-mass index , or number of smokers between the two groups . However , significantly more patients in the intervention group than in the care as usual group achieved target cholesterol values after 18 months ( 48 % versus 27 % , P = 0.002 and remained significant after Bonferroni-Holms correction ) but not after 9 months of follow-up ( 31 % versus 27 % , P > 0.2 ) . CONCLUSION This hospital-based case-management and outreach program , limited to counseling by a clinician , did not substantially improve cardiovascular risk factor control among patients hospitalized for coronary events
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 .