Cardiovascular secondary prevention in high-risk patients: a randomized controlled trial sub-study

BMC Cardiovascular Disorders

Thomas Mooe¹  Fredrik Bjorklund¹  Anna-Lotta Irewall¹  Stina Jakobsson¹ 

[1] Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden

关键词: Cardiovascular disease;    Secondary prevention;    Chronic renal insufficiency;    Diabetes mellitus;    Transient ischemic attack;    Stroke;    Myocardial infarction;    Acute coronary syndrome;   

Others  :  1229134
DOI  :  10.1186/s12872-015-0115-0

 received in 2015-06-28, accepted in 2015-09-25,  发布年份 2015

【 摘 要 】

Background

Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients.

Methods

Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient’s general practitioner for assessment.

Results

The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI −1.7 to 26.2 %).

Conclusions

Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.

Trial registration

ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

【 授权许可】

   
2015 Jakobsson et al.

【 图 表 】

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【 参考文献 】

• [1]Dhamoon MS, Tai W, Boden-Albala B, Rundek T, Paik MC, Sacco RL, et al.: Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan study. Stroke 2007, 38(6):1752-8.
• [2]SWEDEHEART Annual report 2014. http://www.ucr.uu.se/swedeheart/index.php/dokument-sh/arsrapporter. 2015.
• [3]Ulvenstam A, Kajermo U, Modica A, Jernberg T, Soderstrom L, Mooe T: Incidence, trends, and predictors of ischemic stroke 1 year after an acute myocardial infarction. Stroke 2014, 45(11):3263-8.
• [4]Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al.: European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012, 33(13):1635-701.
• [5]Alvarez-Sabin J, Quintana M, Hernandez-Presa MA, Alvarez C, Chaves J, Ribo M: Therapeutic interventions and success in risk factor control for secondary prevention of stroke. J Stroke Cerebrovasc Dis 2009, 18(6):460-5.
• [6]Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, et al.: International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006, 295(2):180-9.
• [7]Kotseva K, Wood D, De Bacquer D, De Backer G, Ryden L, Jennings C et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2015. doi:10.1177/2047487315569401.
• [8]Buckley BS, Byrne MC, Smith SM: Service organisation for the secondary prevention of ischaemic heart disease in primary care. Cochrane Database Syst Rev 2010, 3:CD006772.
• [9]Lager KE, Mistri AK, Khunti K, Haunton VJ, Sett AK, Wilson AD: Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2014, 5:CD009103.
• [10]Neubeck L, Redfern J, Fernandez R, Briffa T, Bauman A, Freedman SB: Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil 2009, 16(3):281-9.
• [11]Arnett DK, Goodman RA, Halperin JL, Anderson JL, Parekh AK, Zoghbi WA: AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and US Department of Health and Human Services. Circulation 2014, 130(18):1662-7.
• [12]Donahoe SM, Stewart GC, McCabe CH, Mohanavelu S, Murphy SA, Cannon CP, et al.: Diabetes and mortality following acute coronary syndromes. JAMA 2007, 298(7):765-75.
• [13]Weiner DE, Tighiouart H, Stark PC, Amin MG, MacLeod B, Griffith JL, et al.: Kidney disease as a risk factor for recurrent cardiovascular disease and mortality. Am J Kidney Dis 2004, 44(2):198-206.
• [14]Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al.: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380(9859):2095-128.
• [15]Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al.: National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011, 378(9785):31-40.
• [16]Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al.: Chronic kidney disease: global dimension and perspectives. Lancet 2013, 382(9888):260-72.
• [17]Mooe T, Bergstrom L, Irewall AL, Ogren J: The NAILED stroke risk factor trial (nurse based age independent intervention to limit evolution of disease after stroke): study protocol for a randomized controlled trial. Trials 2013, 14:5. BioMed Central Full Text
• [18]Mooe T, Bjorklund F, Graipe A, Huber D, Jakobsson S, Kajermo U, et al.: The Nurse-Based Age Independent Intervention to Limit Evolution of Disease After Acute Coronary Syndrome (NAILED ACS) risk factor trial: protocol for a randomized controlled trial. JMIR Res Protoc 2014, 3(3):e42.
• [19]Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al.: A new equation to estimate glomerular filtration rate. Ann Intern Med 2009, 150(9):604-12.
• [20]National KF: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1-266.
• [21]McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, et al.: Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ 2014, 186(8):577-84.
• [22]Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GF: Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2012, 157(4):263-75.