| |
Cardiology Other
|
|
| |
|
|
| |
|
|
|
|
|
my personal edition > cardiology other > news
E-Mail this DGDispatch to a colleague
DGDispatch
Reduced CHD Risk Linked to Better-Informed Patients: Presented at EAS
By Sara Freeman
ISTANBUL, Turkey -- May 5, 2008 -- Patients who undergo a training program to better understand their 10-year Framingham risk score have a significant decrease in their risk score 6 months later, according to a study of patients at 100 clinical centres in 9 European countries.
The results, from the Risk Evaluation and Communication Health Outcomes and Utilization Trial (REACH-OUT), were presented by Leif Erhardt, MD, Professor of Cardiology, Lund University, Malmö, Sweden, here at the 77th European Atherosclerosis Society (EAS) Congress.
Dr. Erhardt noted that the 10-year Framingham risk score can be used to estimate a patient's risk of developing coronary heart disease (CHD) but there have been few studies looking at how its use can be communicated effectively to patients in routine practice or the effect that this has on patient outcomes.
The study randomly allocated each clinical centre to act as an "intervention centre" or a "usual-care centre." Ten to fifteen patients were recruited at each site. Inclusion criteria were mild hypertension, age of 45 to 65 years, no history of CHD, stroke or diabetes, and an estimated 10-year Framingham risk of 10% or greater.
In total, 949 men and 154 women participated in the 24-week study. Dr. Erhardt noted that more men than women were included because women tend to get CHD at an older age and the upper age limit for inclusion in this study was 65 years.
The 494 men and 71 women in the intervention group received a simple 2-sided report that explained the patient's heart health, blood pressure and lipid levels compared with normal values, and provided a graphic depiction of the patient's current Framingham risk and the estimated risk 6 months later if the patient followed the doctor's advice. Patients were given the report and were interviewed on their progress by a physician or nurse at 6, 12, and 18 weeks. By comparison, the 455 men and 83 women in the usual-care group participated in heart screening and end-of-study evaluations.
After 6 months, the mean predicted 10-year risk of CHD decreased to 12.5% from 17.2% at baseline among patients in the intervention arm and to 13.7% from 16.9% at baseline in the usual-care group (P < .001).
In addition, the intervention group had greater mean decreases in systolic blood pressure (-20.3% vs -15.4%; P = .001) and diastolic blood pressure (-9.9% vs -7.3%; P = .003) compared with the usual-care group.
The percentages of patients achieving European systolic blood pressure targets (<140 mm Hg) and low-density lipoprotein cholesterol (LDL-C) targets (<3.4 mmol/L [130 mg/dL]) were greater in patients in the intervention group, Dr. Erhardt noted in his presentation on April 28.
Changes in total cholesterol, LDL-C, and high-density lipoprotein cholesterol were significantly improved in the intervention group and in the usual-care group, but did not differ significantly between the 2 groups.
From a clinical perspective, Dr. Erhardt said, the most impressive finding of the study was that one quarter of the patients in the intervention arm reached both blood pressure and LDL-C targets.
He concluded, "REACH-OUT supports the role of global CHD risk-assessment and risk-factor education in CHD prevention."
[Presentation title: Predicted Risk Is Reduced by an Intervention Program to Evaluate/Communicate 10-Year CHD Risk Versus Usual Care: The REACH OUT Study. Abstract WO11-OR4]
All contents Copyright (c) 1995-2008 Doctor's Guide Publishing Limited. All rights reserved.
|
