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RESPONSE: Nurse-gedreven preventie verlaagt cardiaal risico bij CAD

Nieuws - Aug. 30, 2010

RESPONSE: Nurse-led prevention programme lowers cardiac risk in CAD patients

31 August 2010

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Stockholm, Sweden - Cardiovascular risk factors are significantly and sustainably reduced in coronary artery disease (CAD) patients by a 6-month, nurse-led outpatient prevention programme, RESPONSE study findings indicate.

Over 750 patients hospitalized for an acute coronary complication, comprising myocardial infarction (MI) or impending MI, were randomized to usual care alone or usual care plus a 6-month nursing intervention consisting of four extra visits to the outpatient clinic, at which they were given healthy lifestyle advice and monitored for major risk factors and the use of preventive medicine. Using the SCORE function to assess their 10-year cardiovascular mortality risk, the nurse-led intervention was associated with a significant risk reduction of almost 17%, as well as a significant increase in the good control of cardiovascular risk factors, and significant reductions in low-density lipoprotein (LDL) cholesterol levels and systolic blood pressure.


  Nurse-led intervention Usual care alone Relative risk reduction p-value
SCORE 10-year cardiovascular risk estimate 4.5% 4.5% 16.9% 0.029
Control of risk factors

Poor (0-3 factors on target)
Medium (4-6 factors on target)
Good (7-9 factors on target)


4.5%
59.9%
35.6%


8.9%
65.2%
25.9%
 

0.023
0.161
0.006
Significantly altered targets

Systolic blood pressure ≤ 140 mmHg
LDL cholesterol ≤ 2.5 mmol/L
Physical activity ≥ 30 minutes ≥ 5 times per week
Vegetable consumption ≥ 200 g/day
Fruit ≥ 2 pieces/day


74%
73%
67%

81%
94%


61%
64%
54%

71%
85%




<0.001
0.013
0.001

0.002
<0.001

Lead investigator Ron Peters (University of Amsterdam, The Netherlands) commented: “It is widely believed, both by patients and doctors, that the preventive aspect of treatment is given insufficient priority and that new approaches are needed to realize the full benefits of prevention. A short coaching programme by a nurse, on top of usual care, is such a new approach already found promising in primary care.”

Study details
In the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists (RESPONSE) study, 754 patients aged 18-80 years who experienced an acute coronary syndrome ≤ 8 weeks previously were randomized to a nurse-coordinated prevention programme alongside usual care or usual care alone. The intervention comprised up to four outpatient visits to a nurse during the first 6 months. The protocol was based on current guidelines and focused on healthy lifestyles (smoking cessation, adequate physical exercise and healthy weight/fat distribution), biometric risk factors (blood pressure control, lipid control, screening for diabetes, and glycemic control in diabetics) and medication adherence. Data were independently collected at baseline, and at 6 and 12 months.

The primary endpoint was the SCORE 10-year cardiovascular risk estimation at 12 months. The secondary outcome was the proportion of patients classified as having good control of risk factors, defined as having at least seven of nine risk factors at the target level.

There were no significant differences in baseline characteristics between the intervention and control groups. There was a significant reduction in the SCORE 10-year cardiovascular mortality in the intervention group compared with controls, at 4.5% versus 5.4% (relative risk reduction 16.9%; p=0.029). There was also a significant increase in the proportion of patients achieving good target control at 12 months with the intervention, at 35.6% versus 25.9% (37% increase; p=0.06). Furthermore, the intervention, which was completed by 93% of assigned patients, was linked to significant improvements in LDL cholesterol levels and systolic blood pressure, as well as increases in weekly physical activity, consumption of vegetables, and fruit intake. Adherence to medication was high in both groups and did not differ significantly.

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