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

BMC Cardiovascular Disorders

Research Article

Fredrik Bjorklund¹  Thomas Mooe¹  Stina Jakobsson¹  Anna-Lotta Irewall¹ 

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

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

DOI  :  10.1186/s12872-015-0115-0

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

来源: Springer

【 摘 要 】

BackgroundEnhanced 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.MethodsPatients 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.ResultsThe 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 %).ConclusionsCardiovascular 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 registrationISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

【 授权许可】

CC BY   
© Jakobsson et al. 2015