Lis Neubeck1, Ben Freedman2, Nicole Lowres3, Karice Hyun4, Jessica Orchard5, Tom Briffa6, Adrian Bauman7, Kris Rogers8, Julie Redfern4. 1. School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland; Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia; The George Institute for Global Health, Sydney, NSW, Australia. Electronic address: l.neubeck@napier.ac.uk. 2. Heart Research Institute, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Dept of Cardiology and ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia. 3. Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Heart Research Institute, University of Sydney, Sydney, NSW, Australia. 4. The George Institute for Global Health, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 5. School of Public Health, University of Sydney, Sydney, NSW, Australia. 6. School of Population Health, University of Western Australia, Sydney, NSW, Australia. 7. Dept of Cardiology and ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia. 8. The George Institute for Global Health, Sydney, NSW, Australia.
Abstract
BACKGROUND:Globally, attendance at cardiac rehabilitation (CR) is between 15 and 30%. Alternative models of individualised care are recommended to promote participation in CR, however there has been no prospective testing of different durations of such models. We aimed to replicate the previously proven Choice of Health Options In prevention of Cardiovascular Events (CHOICE) intervention, and to determine if an extended version (CHOICEplus) would confer additional benefits. METHODS:Acute coronary syndrome (ACS) survivors not accessing centre-based CR (n=203) were randomised to CHOICE for 3 months (n=100) or CHOICEplus for 24 months (n=103) at four urban hospitals. The program comprised telephone-based tailored risk-factor reduction. RESULTS: CHOICE and CHOICEplus were equivalent demographically and in risk profile at baseline. At 24 months, lipid profiles improved significantly and fewer patients had ≥3 risk factors above target compared to baseline in both groups. There were no significant differences between groups. CONCLUSIONS: The 24-month CHOICEplus program did not confer additional benefit above the brief 3-month CHOICE intervention. However, participation in either CHOICE and CHOICEplus significantly improved cardiovascular risk profile in ACS survivors. Importantly, the study was feasible, and the intervention translated readily across four hospitals. Overall, this study adds to the existing evidence for brief individualised approaches to CR.
RCT Entities:
BACKGROUND: Globally, attendance at cardiac rehabilitation (CR) is between 15 and 30%. Alternative models of individualised care are recommended to promote participation in CR, however there has been no prospective testing of different durations of such models. We aimed to replicate the previously proven Choice of Health Options In prevention of Cardiovascular Events (CHOICE) intervention, and to determine if an extended version (CHOICEplus) would confer additional benefits. METHODS: Acute coronary syndrome (ACS) survivors not accessing centre-based CR (n=203) were randomised to CHOICE for 3 months (n=100) or CHOICEplus for 24 months (n=103) at four urban hospitals. The program comprised telephone-based tailored risk-factor reduction. RESULTS: CHOICE and CHOICEplus were equivalent demographically and in risk profile at baseline. At 24 months, lipid profiles improved significantly and fewer patients had ≥3 risk factors above target compared to baseline in both groups. There were no significant differences between groups. CONCLUSIONS: The 24-month CHOICEplus program did not confer additional benefit above the brief 3-month CHOICE intervention. However, participation in either CHOICE and CHOICEplus significantly improved cardiovascular risk profile in ACS survivors. Importantly, the study was feasible, and the intervention translated readily across four hospitals. Overall, this study adds to the existing evidence for brief individualised approaches to CR.