The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six
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RESEARCH
Open Access
The effect of post-discharge educational intervention on patients in achieving objectives in modifiable risk factors six months after discharge following an episode of acute coronary syndrome, (CAM-2 Project): a randomized controlled trial Javier Muñiz1*, Juan J Gómez-Doblas2, María I Santiago-Pérez3, Iñaki Lekuona-Goya4, Nekane Murga-Eizagaetxebarría5, Eduardo de Teresa-Galván ß2, José M Cruz-Fernández6, Alfonso Castro-Beiras1,7, Representing the CAM2 Project working group
Abstract Objectives: We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached, improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome. Background: There is room to improve mid-term adherence to clinical guidelines’ recommendations in coronary heart disease secondary prevention, specially non-pharmacological ones, often neglected. Methods: In CAM-2, patients discharged after an acute coronary syndrome were randomly assigned to the intervention or the usual care group. The primary outcome was reaching therapeutic objectives in various secondary prevention variables: smoking, obesity, blood lipids, blood pressure control, exercise and taking of medication. Results: 1757 patients were recruited in 64 hospitals and 1510 (762 in the intervention and 748 in the control group) attended the six-months follow-up visit. After adjustment for potentially important variables, there were, between the intervention and control group, differences in the mean reduction of body mass index (0.5 vs. 0.2; p < 0.001) and waist circumference (1.6 cm vs. 0.6 cm; p = 0.05), proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl (64.7% vs. 56.5%; p = 0.001). The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins (98.1% vs. 95.9%; p = 0.029). Conclusions: At least in the short term, lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention.
Background Clinical practice guidelines recognise a series of pharmacological and hygienic-dietetic measures as being effective for secondary prevention in patients with acute * Correspondence: [email protected] 1 Instituto Universitario de Ciencias de la Salud de la Universidad de A Coruña. Spain Full list of author information is available at the end of the article
coronary syndrome [1]. However, in spite of the improvement in recent years in measures to assure compliance in secondary prevention in post-infarct patients, there still exists considerable room for improvement [2-9]. Adherence to the treatment recommended has a favourable effect on the evolution of those patients who comply. In patients with coronary heart disease, following the recommendations of clinical guidelines in
© 2010 Muñiz et al
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