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Cardiovascular secondary prevention in high-risk patients: a randomized controlled trial sub-study.

Jakobsson S, Irewall AL, Bjorklund F, Mooe T - BMC Cardiovasc Disord (2015)

Bottom Line: Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26).Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. stina.jakobsson@umu.se.

ABSTRACT

Background: Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients.

Methods: Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient's general practitioner for assessment.

Results: The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI -1.7 to 26.2 %).

Conclusions: Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.

Trial registration: ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

No MeSH data available.


Related in: MedlinePlus

Proportion of patients reaching target LDL-C, SBP and DBP. *The proportion reported for control patients is the same as at baseline since control patients did not receive any medication titration within the study period
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Fig3: Proportion of patients reaching target LDL-C, SBP and DBP. *The proportion reported for control patients is the same as at baseline since control patients did not receive any medication titration within the study period

Mentions: Figure 3 shows the proportion of patients who met all target values (LDL-C, SBP and DBP) at baseline, after medication titration, and at 12 months. At baseline this proportion did not differ between the groups (intervention 34.2 % [76/222] versus control 35.1 % [74/211]; absolute difference of 0.8 %, 95 % CI −8.1 to 9.8 %). After medication titration, 83.8 % (186/222) of the patients in the intervention group reached all target values (including patients who already showed target values at baseline) (absolute difference of 48.7 %, 95 % CI 40.1 to 56.2 %). At 12 months 40.0 % (88/220) of the intervention patients and 28.2 % (59/209) of the control patients met all target values (absolute difference of 11.8 %, 95 % CI 2.8 to 20.5 %).Fig. 3


Cardiovascular secondary prevention in high-risk patients: a randomized controlled trial sub-study.

Jakobsson S, Irewall AL, Bjorklund F, Mooe T - BMC Cardiovasc Disord (2015)

Proportion of patients reaching target LDL-C, SBP and DBP. *The proportion reported for control patients is the same as at baseline since control patients did not receive any medication titration within the study period
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4607173&req=5

Fig3: Proportion of patients reaching target LDL-C, SBP and DBP. *The proportion reported for control patients is the same as at baseline since control patients did not receive any medication titration within the study period
Mentions: Figure 3 shows the proportion of patients who met all target values (LDL-C, SBP and DBP) at baseline, after medication titration, and at 12 months. At baseline this proportion did not differ between the groups (intervention 34.2 % [76/222] versus control 35.1 % [74/211]; absolute difference of 0.8 %, 95 % CI −8.1 to 9.8 %). After medication titration, 83.8 % (186/222) of the patients in the intervention group reached all target values (including patients who already showed target values at baseline) (absolute difference of 48.7 %, 95 % CI 40.1 to 56.2 %). At 12 months 40.0 % (88/220) of the intervention patients and 28.2 % (59/209) of the control patients met all target values (absolute difference of 11.8 %, 95 % CI 2.8 to 20.5 %).Fig. 3

Bottom Line: Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26).Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Clinical Medicine, Division of Medicine, Ostersund sjukhus, Umea University, Umea, Sweden. stina.jakobsson@umu.se.

ABSTRACT

Background: Enhanced cardiovascular secondary preventive follow-up is needed to improve adherence to recommended low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) levels. Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of recurrent events. Secondary prevention is therefore essential in these patients.

Methods: Patients with acute coronary syndrome, stroke, or transient ischemic attack were randomized to nurse-based telephone follow-up (intervention) or usual care (control). LDL-C and BP were measured at 1 month (baseline) and 12 months post-discharge. Intervention patients with above-target values at baseline received medication titration to achieve treatment goals. Values measured for control patients were given to the patient's general practitioner for assessment.

Results: The final analyses included 225 intervention and 215 control patients with DM or CKD. Among patients with above-target baseline values, the following 12-month values were recorded for intervention and control patients, respectively: LDL-C, 2.2 versus 3.0 mmol/L (p < 0.001); and median systolic BP (SBP), 140 versus 145 mmHg (p = 0.26). Among patients with above-target values at baseline, 52.3 % of intervention patients reached target LDL-C values at 12 months versus 21.3 % of control patients (absolute difference of 30.9 %, 95 % CI 16.1 to 43.8 %), and there was a non-significant trend of more intervention patients reaching target SBP (49.4 % versus 36.8 %; absolute difference of 12.6 %, 95 % CI -1.7 to 26.2 %).

Conclusions: Cardiovascular secondary prevention with nurse-based telephone follow-up was more effective than usual care in improving LDL-C levels 12 months after discharge for patients with DM or CKD.

Trial registration: ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).

No MeSH data available.


Related in: MedlinePlus