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The CHOICE (Choice of Health Options In prevention of Cardiovascular Events) replication trial: study protocol.

Neubeck L, Redfern J, Briffa T, Bauman A, Hare D, Freedman SB - BMC Cardiovasc Disord (2008)

Bottom Line: CHOICE-plus will also receive additional face-to-face and telephone reinforcement between three and 30 months.Primary outcomes are lipid levels, blood pressure, physical activity levels and smoking rates.Secondary outcomes include readmission rates, death, the number of risk factors, other modifiable risk factors, quality of life and process evaluation measures over three years.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia. lneubeck@med.usyd.edu.au

ABSTRACT

Background: Although morbidity and mortality from coronary heart disease (CHD) are high, only a minority of acute coronary syndrome (ACS) survivors accesses an effective secondary prevention program. We aim to determine whether the previously proven CHOICE program can be replicated at multiple sites and whether ongoing reinforcement further improves risk factor modification.

Methods/design: Participants eligible for but not accessing standard cardiac rehabilitation will be randomly allocated to either a previously tested 3-month CHOICE program or a 30-month CHOICE program (CHOICE-plus). Both groups will participate in individualised risk factor modules of differing duration that involve choice, goal setting and telephone follow-up for three months. CHOICE-plus will also receive additional face-to-face and telephone reinforcement between three and 30 months. At one site we will recruit a randomised control group, receiving conventional care. Primary outcomes are lipid levels, blood pressure, physical activity levels and smoking rates. Secondary outcomes include readmission rates, death, the number of risk factors, other modifiable risk factors, quality of life and process evaluation measures over three years.

Discussion: We present the rationale and design of a multi-centre, replication study testing a modular approach for the secondary prevention of CHD following an ACS.

Trial registration: [Clinical Trial Registration Number, ACTRN12608000182392].

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Model of CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program after acute coronary syndrome (ACS).
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Figure 2: Model of CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program after acute coronary syndrome (ACS).

Mentions: As described elsewhere, the CHOICE intervention includes a one-hour initial consultation and follow-up phone calls over three months [20]. The program is designed to have an individualised, structured, case-management approach and is overseen by treating physicians. The development and implementation of the CHOICE program can be divided into four stages (figure 2). Stage one involves the development of modules and tailoring of leaflets to access recommended local services [21]. Stage two is a face-to-face risk factor assessment, lasting approximately one hour in which the patient is assisted to generate a list of their own relevant risk factors. In stage three, patients make guided choices about which risk factors they will address, participate in realistic goal-setting informed by national targets (table 1) [9] and then select management option(s) for lowering risk. The relevant patient information leaflets, described in Stage 1, support these choices. All CHOICE patients participate in the core module for lowering cholesterol as well as up to two choice modules from blood pressure (BP)-lowering, smoking cessation, increased physical activity and nutrition. Patients will have the option to add additional modules on completion of the three-month program. Additional module information will be given over the telephone and written information will be mailed to the patient. Stage four, is telephone follow-up, consisting of approximately four calls of around 10 minutes duration over a three-month period, during which each patient's risk factor(s) goals and strategies are re-evaluated and mutually changed if necessary. CHOICE-plus patients will receive additional telephone follow-up over 3 years as previously outlined (figure 1).


The CHOICE (Choice of Health Options In prevention of Cardiovascular Events) replication trial: study protocol.

Neubeck L, Redfern J, Briffa T, Bauman A, Hare D, Freedman SB - BMC Cardiovasc Disord (2008)

Model of CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program after acute coronary syndrome (ACS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572037&req=5

Figure 2: Model of CHOICE (Choice of Health Options In prevention of Cardiovascular Events) program after acute coronary syndrome (ACS).
Mentions: As described elsewhere, the CHOICE intervention includes a one-hour initial consultation and follow-up phone calls over three months [20]. The program is designed to have an individualised, structured, case-management approach and is overseen by treating physicians. The development and implementation of the CHOICE program can be divided into four stages (figure 2). Stage one involves the development of modules and tailoring of leaflets to access recommended local services [21]. Stage two is a face-to-face risk factor assessment, lasting approximately one hour in which the patient is assisted to generate a list of their own relevant risk factors. In stage three, patients make guided choices about which risk factors they will address, participate in realistic goal-setting informed by national targets (table 1) [9] and then select management option(s) for lowering risk. The relevant patient information leaflets, described in Stage 1, support these choices. All CHOICE patients participate in the core module for lowering cholesterol as well as up to two choice modules from blood pressure (BP)-lowering, smoking cessation, increased physical activity and nutrition. Patients will have the option to add additional modules on completion of the three-month program. Additional module information will be given over the telephone and written information will be mailed to the patient. Stage four, is telephone follow-up, consisting of approximately four calls of around 10 minutes duration over a three-month period, during which each patient's risk factor(s) goals and strategies are re-evaluated and mutually changed if necessary. CHOICE-plus patients will receive additional telephone follow-up over 3 years as previously outlined (figure 1).

Bottom Line: CHOICE-plus will also receive additional face-to-face and telephone reinforcement between three and 30 months.Primary outcomes are lipid levels, blood pressure, physical activity levels and smoking rates.Secondary outcomes include readmission rates, death, the number of risk factors, other modifiable risk factors, quality of life and process evaluation measures over three years.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Medicine, University of Sydney, Sydney, Australia. lneubeck@med.usyd.edu.au

ABSTRACT

Background: Although morbidity and mortality from coronary heart disease (CHD) are high, only a minority of acute coronary syndrome (ACS) survivors accesses an effective secondary prevention program. We aim to determine whether the previously proven CHOICE program can be replicated at multiple sites and whether ongoing reinforcement further improves risk factor modification.

Methods/design: Participants eligible for but not accessing standard cardiac rehabilitation will be randomly allocated to either a previously tested 3-month CHOICE program or a 30-month CHOICE program (CHOICE-plus). Both groups will participate in individualised risk factor modules of differing duration that involve choice, goal setting and telephone follow-up for three months. CHOICE-plus will also receive additional face-to-face and telephone reinforcement between three and 30 months. At one site we will recruit a randomised control group, receiving conventional care. Primary outcomes are lipid levels, blood pressure, physical activity levels and smoking rates. Secondary outcomes include readmission rates, death, the number of risk factors, other modifiable risk factors, quality of life and process evaluation measures over three years.

Discussion: We present the rationale and design of a multi-centre, replication study testing a modular approach for the secondary prevention of CHD following an ACS.

Trial registration: [Clinical Trial Registration Number, ACTRN12608000182392].

Show MeSH
Related in: MedlinePlus