Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

Harald T Jorstad; Clemens von Birgelen; A Marco W Alings; Anho Liem; Jan Melle van Dantzig; Wybren Jaarsma; Dirk J A Lok; Hans J A Kragten; Keesjan de Vries; Paul A R de Milliano; Adrie J A M Withagen; Wilma J M Scholte Op Reimer; Jan G P Tijssen; Ron J G Peters

doi:10.1136/heartjnl-2013-303989

Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

Harald T Jorstad
, Clemens von Birgelen
, A Marco W Alings
, Anho Liem
, Jan Melle van Dantzig
, Wybren Jaarsma
, Dirk J A Lok
, Hans J A Kragten
, Keesjan de Vries
, Paul A R de Milliano
, Adrie J A M Withagen
, Wilma J M Scholte Op Reimer
, Jan G P Tijssen
, Ron J G Peters

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	1421-30
Number of pages	10
Journal	Heart
Volume	99
Issue number	19
DOIs	https://doi.org/10.1136/heartjnl-2013-303989
Publication status	Published - Oct 2013
Externally published	Yes

Keywords

Acute Coronary Syndrome/mortality
Aged
Ambulatory Care
Chi-Square Distribution
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Medication Adherence
Middle Aged
Netherlands
Patient Education as Topic
Risk Assessment
Risk Factors
Risk Reduction Behavior
Secondary Prevention/methods
Time Factors
Treatment Outcome

Access to Document

10.1136/heartjnl-2013-303989

Cite this

Jorstad, H. T., von Birgelen, C., Alings, A. M. W., Liem, A., van Dantzig, J. M., Jaarsma, W., Lok, D. J. A., Kragten, H. J. A., de Vries, K., de Milliano, P. A. R., Withagen, A. J. A. M., Scholte Op Reimer, W. J. M., Tijssen, J. G. P., & Peters, R. J. G. (2013). Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Heart, 99(19), 1421-30. https://doi.org/10.1136/heartjnl-2013-303989

@article{e2e9cfe55ea54f9ba76345b9452f1760,

title = "Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial",

abstract = "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.",

keywords = "Acute Coronary Syndrome/mortality, Aged, Ambulatory Care, Chi-Square Distribution, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Medication Adherence, Middle Aged, Netherlands, Patient Education as Topic, Risk Assessment, Risk Factors, Risk Reduction Behavior, Secondary Prevention/methods, Time Factors, Treatment Outcome",

author = "Jorstad, \{Harald T\} and \{von Birgelen\}, Clemens and Alings, \{A Marco W\} and Anho Liem and \{van Dantzig\}, \{Jan Melle\} and Wybren Jaarsma and Lok, \{Dirk J A\} and Kragten, \{Hans J A\} and \{de Vries\}, Keesjan and \{de Milliano\}, \{Paul A R\} and Withagen, \{Adrie J A M\} and \{Scholte Op Reimer\}, \{Wilma J M\} and Tijssen, \{Jan G P\} and Peters, \{Ron J G\}",

year = "2013",

month = oct,

doi = "10.1136/heartjnl-2013-303989",

language = "English",

volume = "99",

pages = "1421--30",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "19",

}

Jorstad, HT, von Birgelen, C, Alings, AMW, Liem, A, van Dantzig, JM, Jaarsma, W, Lok, DJA, Kragten, HJA, de Vries, K, de Milliano, PAR, Withagen, AJAM, Scholte Op Reimer, WJM, Tijssen, JGP & Peters, RJG 2013, 'Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial', Heart, vol. 99, no. 19, pp. 1421-30. https://doi.org/10.1136/heartjnl-2013-303989

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 -

Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

Abstract

Keywords

Access to Document

Fingerprint

Cite this