Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Issue 19 (28th June 2013)

• Record Type: Journal Article
• Authors: Jorstad, Harald T; von Birgelen, Clemens; Alings, A Marco W; Liem, Anho; van Dantzig, Jan Melle; Jaarsma, Wybren; Lok, Dirk J A; Kragten, Hans J A; de Vries, Keesjan; de Milliano, Paul A R; Withagen, Adrie J A M; Scholte op Reimer, Wilma J M; Tijssen, Jan G P; Peters, Ron J G
• Is Part Of: Heart. Volume 99:Issue 19(2013)
• Page Start: 1421
• Page End: 1430
• Publication Date: 2013-06-28
• Subjects: Coronary Artery Disease; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2013-303989
• Languages: English
• ISSNs: 1355-6037

Abstract

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 trialregister.nl Identifier: TC1290.