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- Title
Cardiovascular secondary prevention in high-risk patients: a randomized controlled trial sub-study.
- Authors
Jakobsson, Stina; Irewall, Anna-Lotta; Bjorklund, Fredrik; Mooe, Thomas
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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 %).<bold>Conclusions: </bold>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.<bold>Trial Registration: </bold>ISRCTN registry; ISRCTN96595458 (date of registration 10 July 2011) and ISRCTN23868518 (date of registration 13 May 2012).
- Subjects
ANTIHYPERTENSIVE agents; DISEASE relapse prevention; CHRONIC kidney failure complications; TRANSIENT ischemic attack prevention; STROKE prevention; COMPARATIVE studies; DIABETES; DIABETIC angiopathies; LOW density lipoproteins; RESEARCH methodology; MEDICAL cooperation; RESEARCH; STROKE; TELEPHONES; DISEASE relapse; TRANSIENT ischemic attack; EVALUATION research; RANDOMIZED controlled trials; ACUTE coronary syndrome; DISEASE complications; PREVENTION
- Publication
BMC Cardiovascular Disorders, 2015, Vol 15, Issue 1, p125
- ISSN
1471-2261
- Publication type
journal article
- DOI
10.1186/s12872-015-0115-0