TY - JOUR
T1 - Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: 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
Y1 - 2013
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 12months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12months, 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 12months 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 12months, 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 trialregister.nl 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 12months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12months, 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 12months 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 12months, 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 trialregister.nl Identifier TC1290
U2 - https://doi.org/10.1136/heartjnl-2013-303989
DO - https://doi.org/10.1136/heartjnl-2013-303989
M3 - Article
C2 - 23813851
SN - 1355-6037
VL - 99
SP - 1421
EP - 1430
JO - Heart (British Cardiac Society)
JF - Heart (British Cardiac Society)
IS - 19
ER -