Madelon Minneboo1, Sangeeta Lachman1, Marjolein Snaterse2, Harald T Jørstad1, Gerben Ter Riet3, S Matthijs Boekholdt1, Wilma J M Scholte Op Reimer4, Ron J G Peters5. 1. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. 2. ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. 3. Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands. 4. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. 5. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: r.j.peters@amc.uva.nl.
Abstract
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/m2, self-reported physical inactivity, and/or smoking) were included. All patients received guideline-based usual care. The intervention was based on 3 lifestyle programs for weight reduction, increasing physical activity, and smoking cessation. The primary outcome was the proportion of success at 12 months, defined as improvement in ≥1 qualifying LRF using weight (≥5% reduction), 6-min-walking distance (≥10% improvement), and urinary cotinine (200 ng/ml detection limit) without deterioration in the other 2. 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).
RCT Entities:
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/m2, self-reported physical inactivity, and/or smoking) were included. All patients received guideline-based usual care. The intervention was based on 3 lifestyle programs for weight reduction, increasing physical activity, and smoking cessation. The primary outcome was the proportion of success at 12 months, defined as improvement in ≥1 qualifying LRF using weight (≥5% reduction), 6-min-walking distance (≥10% improvement), and urinary cotinine (200 ng/ml detection limit) without deterioration in the other 2. 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).
Authors: David A Katz; Donna M Buchanan; Mark W Vander Weg; Babalola Faseru; Philip A Horwitz; Philip G Jones; John A Spertus Journal: Prev Med Date: 2018-10-11 Impact factor: 4.018
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Authors: Grace Dibben; James Faulkner; Neil Oldridge; Karen Rees; David R Thompson; Ann-Dorthe Zwisler; Rod S Taylor Journal: Cochrane Database Syst Rev Date: 2021-11-06
Authors: Lotte Verweij; Denise F Spoon; Michel S Terbraak; Patricia Jepma; Ron J G Peters; Wilma J M Scholte Op Reimer; Corine H M Latour; Bianca M Buurman Journal: J Adv Nurs Date: 2021-02-17 Impact factor: 3.187
Authors: Patricia Jepma; Harald T Jorstad; Marjolein Snaterse; Gerben Ter Riet; Hans Kragten; Sangeeta Lachman; Madelon Minneboo; S Matthijs Boekholdt; Ron J Peters; Wilma Scholte Op Reimer Journal: Heart Date: 2020-03-16 Impact factor: 5.994
Authors: T Vromen; R W M Brouwers; H T Jorstad; R A Kraaijenhagen; R F Spee; M E Wittekoek; M J Cramer; J M C van Hal; L Hofstra; P M J C Kuijpers; E C de Melker; S F Rodrigo; M Sunamura; N H M K Uszko-Lencer; H M Kemps Journal: Neth Heart J Date: 2021-06-10 Impact factor: 2.380
Authors: Peter E H Schwarz; Patrick Timpel; Lorenz Harst; Colin J Greaves; Mohammed K Ali; Jeffrey Lambert; Mary Beth Weber; Mohamad M Almedawar; Henning Morawietz Journal: J Am Coll Cardiol Date: 2018-10-09 Impact factor: 24.094