TY - JOUR
T1 - Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome
T2 - main results of the RESPONSE randomised trial
AU - Jorstad, Harald T
AU - von Birgelen, Clemens
AU - Alings, A Marco W
AU - Liem, Anho
AU - van Dantzig, Jan Melle
AU - Jaarsma, Wybren
AU - Lok, Dirk J A
AU - Kragten, Hans J A
AU - de Vries, Keesjan
AU - de Milliano, Paul A R
AU - Withagen, Adrie J A M
AU - Scholte Op Reimer, Wilma J M
AU - Tijssen, Jan G P
AU - Peters, Ron J G
PY - 2013/10
Y1 - 2013/10
N2 - OBJECTIVE: To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.DESIGN: RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.SETTING: Multicentre trial in secondary and tertiary healthcare settings.PARTICIPANTS: 754 patients admitted for acute coronary syndrome.INTERVENTION: A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care.MAIN OUTCOME MEASURES: The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target.RESULTS: The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023).CONCLUSIONS: The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions.TRIAL REGISTRATION TRIALREGISTERNL IDENTIFIER: TC1290.
AB - OBJECTIVE: To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.DESIGN: RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.SETTING: Multicentre trial in secondary and tertiary healthcare settings.PARTICIPANTS: 754 patients admitted for acute coronary syndrome.INTERVENTION: A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care.MAIN OUTCOME MEASURES: The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target.RESULTS: The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023).CONCLUSIONS: The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions.TRIAL REGISTRATION TRIALREGISTERNL IDENTIFIER: TC1290.
KW - Acute Coronary Syndrome/mortality
KW - Aged
KW - Ambulatory Care
KW - Chi-Square Distribution
KW - Female
KW - Health Knowledge, Attitudes, Practice
KW - Humans
KW - Male
KW - Medication Adherence
KW - Middle Aged
KW - Netherlands
KW - Patient Education as Topic
KW - Risk Assessment
KW - Risk Factors
KW - Risk Reduction Behavior
KW - Secondary Prevention/methods
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1136/heartjnl-2013-303989
DO - 10.1136/heartjnl-2013-303989
M3 - Article
C2 - 23813851
SN - 1355-6037
VL - 99
SP - 1421
EP - 1430
JO - Heart
JF - Heart
IS - 19
ER -