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 randomized controlled trial of an extensive lifestyle management intervention (ELMI) following cardiac rehabilitation: study design and baseline data
Background Cardiac rehabilitation programs ( CRP ) represent comprehensive interventions that are typically limited to four months . Following completion of CRP , it appears that risk factors and lifestyle behaviours may deteriorate . The Extensive Lifestyle Management Intervention ( ELMI ) Following Cardiac Rehabilitation trial will investigate the benefits of a r and omized intervention to prevent these adverse changes . Methods Patients with ischemic heart disease ( IHD ) were r and omized following a st and ard CRP to the ELMI or to usual care .  The ELMI program is a case-managed intervention aim ed at individualizing risk factor and lifestyle management based on current treatment guidelines . The program consists of cardiac rehabilitation sessions , telephone follow-up and risk factor and lifestyle counselling sessions . Health professionals work with participants using behavioural counselling and communications with participants ' family physicians . Usual care participants return to their family physicians ' care , and come to the study clinic only to undergo annual outcomes assessment . The primary outcome is change in IHD global risk after four years . Secondary outcomes include combined cardiovascular events , health care utilization , lifestyle adherence , quality of life and risk factors . Results Over 28 months , 302 men and women were r and omized . This represented 29 % of the total population screened . The average age of study participants is 64 years , 18 % are women , 53 % have had a previous myocardial infa rct ion , 73 % have undergone previous revascularization and 20 % have diabetes mellitus .  Ischemic heart disease risk factors for the entire cohort improved significantly after subjects had gone through previous CRPs . Baseline risk factors , lifestyle behaviours and medications were similar between the groups . Conclusions This study population is representative of patients completing a st and ard CRP  . Results of the ELMI trial will provide valuable information for the future design of CRPs
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 .