Key result
Nurse-coordinated referral to community-based lifestyle programs significantly increased the proportion of patients successfully improving risk factors compared to control (37% vs 26%; RR 1.43; 95% CI 1.14-1.78; P=0.002).
Why the study?
Improving lifestyle-related risk factors reduces cardiovascular morbidity and mortality in coronary artery disease but remains challenging, prompting evaluation of combining community-based lifestyle programs with regular hospital-based secondary prevention.
RCT (n=824)
randomized
Yes
Relative Risk: 1.43 (95% CI 1.14–1.78)
Absolute Event Rate: 37% vs 26%
p-value: p=0.002
Supports partner-inclusive lifestyle programs in CAD; leaves open confirmation on clinical events in randomized trials.
BACKGROUND: Among patients with coronary artery disease (CAD), improvement of lifestyle-related risk factors (LRFs) reduces cardiovascular morbidity and mortality. However, modification of LRFs is highly challenging. OBJECTIVES: This study sought to evaluate the impact of combining community-based lifestyle programs with regular hospital-based secondary prevention. METHODS: The authors performed a randomized controlled trial of nurse-coordinated referral of patients and their partners to 3 widely available community-based lifestyle programs, in 15 hospitals in the Netherlands. Patients admitted for acute coronary syndrome and/or revascularization, with ≥1 LRF (body mass index >27 kg/m RESULTS: The authors randomized 824 patients. Complete data on the primary outcome were available in 711 patients. The proportion of successful patients in the intervention group was 37% (133 of 360) compared with 26% (91 of 351) in the control group (p = 0.002; risk ratio: 1.43; 95% confidence interval: 1.14 to 1.78). In the intervention group, partner participation was associated with a significantly greater success rate (46% vs. 34%; p = 0.03). CONCLUSIONS: Among patients with coronary artery disease, nurse-coordinated referral to a comprehensive set of community-based, widely available lifestyle interventions, with optional partner participation, leads to significant improvements in LRFs. (RESPONSE-2: Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2; NTR3937).
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Minneboo et al. (2017) conducted an RCT in Coronary Artery Disease (n=824). Nurse-coordinated referral to community-based lifestyle programs vs. Control group (regular hospital-based secondary prevention) was evaluated on Proportion of successful patients (improvement in lifestyle-related risk factors) (RR 1.43, 95% CI 1.14-1.78, p=0.002). Nurse-coordinated referral to community-based lifestyle programs significantly increased the proportion of patients successfully improving risk factors compared to control (37% vs 26%; RR 1.43; 95% CI 1.14-1.78; P=0.002).
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