A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile
Summary Aims: We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients’ predicted Framingham CHD risk vs. usual care. Methods: The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, contro...
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Published in | International journal of clinical practice (Esher) Vol. 62; no. 10; pp. 1484 - 1498 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Publishing Ltd
01.10.2008
Blackwell Hindawi Limited |
Subjects | |
Online Access | Get full text |
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Summary: | Summary
Aims: We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients’ predicted Framingham CHD risk vs. usual care.
Methods: The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster‐randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients’ predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients’ risk and provided usual care only. The primary end‐point was Framingham 10‐year CHD risk at 6 months with intervention vs. usual care.
Results: Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low‐density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04).
Conclusions: A physician‐implemented CHD risk evaluation/communication programme improved patients’ modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice. |
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Bibliography: | ArticleID:IJCP1872 istex:986D1371AB125650E79ED63CB7E1136067028DBE ark:/67375/WNG-0M9D5C2K-B Disclosures L. Erhardt C. Yunis are employees of Pfizer Inc. Z. Gaciong has received research contracts and acted as speaker and consultant for Pfizer Inc. has received research grants from Pfizer Inc, Merck, Amgen and Johnson & Johnson and has served on advisory boards for Pfizer Inc, Servier, Lundbeck, Novartis and Celgene. are employees of IMS Health, Inc., and as such have provided paid research and consulting services to Pfizer Inc. Re‐use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. and X. Girerd R. A. Moller E. S. Johnson J. Garcia‐Puig J. S. Benner M. C. J. M. Sturkenboom , REACH OUT, the Risk Evaluation And Communication Health Outcomes and Utilization Trial. N. Rajicic has received honoraria and acted as consultant for Pfizer Inc. S. B. Cherry has acted as speaker and consultant for Pfizer Inc, Novartis, Takeda and Boehringer Ingelheim. has received research grants from Pfizer Inc and has acted as a speaker and consultant for Pfizer Inc, MSD and AstraZeneca. K. Changela has acted as consultant for Pfizer Inc. M. Flammer ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23 Disclosures J. S. Benner and S. B. Cherry are employees of IMS Health, Inc., and as such have provided paid research and consulting services to Pfizer Inc. L. Erhardt has received research grants from Pfizer Inc and has acted as a speaker and consultant for Pfizer Inc, MSD and AstraZeneca. M. Flammer, R. A. Moller, N. Rajicic, K. Changela and C. Yunis are employees of Pfizer Inc. Z. Gaciong has received research contracts and acted as speaker and consultant for Pfizer Inc. J. Garcia-Puig has acted as speaker and consultant for Pfizer Inc, Novartis, Takeda and Boehringer Ingelheim. E. S. Johnson has received honoraria and acted as consultant for Pfizer Inc. X. Girerd has acted as consultant for Pfizer Inc. M. C. J. M. Sturkenboom has received research grants from Pfizer Inc, Merck, Amgen and Johnson & Johnson and has served on advisory boards for Pfizer Inc, Servier, Lundbeck, Novartis and Celgene. |
ISSN: | 1368-5031 1742-1241 1742-1241 |
DOI: | 10.1111/j.1742-1241.2008.01872.x |