Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care Selection bias in enrollment to a programme aimed at the secondary prevention of ischaemic heart disease in general practice: a cohort study. Multi-dimensional nursing form: a novel means of approaching nurse-led secondary cardiology prevention. Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411] Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial Influence of coronary nursing management follow up on lifestyle after acute myocardial infarction. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial Effects of secondary prevention clinics on health status in patients with coronary heart disease: 4 year follow-up of a randomized trial in primary care. Long-Term Effects on Cholesterol Levels and the Utilization of Lipid-Lowering Drugs of a Hospital-Based Programme for Secondary Prevention of Coronary Artery Disease Effects of a post-hospitalization group health education programme for patients with coronary heart disease. Improved physical fitness and quality of life following training of elderly patients after acute coronary events. A 1 year follow-up randomized controlled study. Physical performance is associated with markers of vascular inflammation in patients with coronary heart disease A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3) Cardiac rehabilitation services in England and Wales: a national survey. 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Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial [Effectiveness of the cooperative program of multifactorial prevention of ischemic heart disease (results of the 3-year study)]. Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme Acute coronary syndromes: cardiac rehabilitation programmes and quality of life. Predictability of psychic outcome for exercise training and exercise training including relaxation therapy after myocardial infarction. The effect of statins versus untreated dyslipidaemia on renal function in patients with coronary heart disease. A subgroup analysis of the Greek atorvastatin and coronary heart disease evaluation (GREACE) study All-cause mortality of patients with dyslipidemia up to 19 years after a multidisciplinary lifestyle modification programme: a randomized trial Risk of fatal coronary heart disease in familial hypercholesterolaemia. Scientific Steering Committee on behalf of the Simon Broome Register Group. The effect of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft. An evidence-based shared decision making programme on the prevention of myocardial infarction in type 2 diabetes: protocol of a randomised-controlled trial Effects of a health advocacy, counselling, and activation programme on depressive symptoms in older coronary heart disease patients. Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial Improving population-based cervical cancer screening in general practice: effects of a national strategy.
Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males Findings of systematic review s incorporating meta analysis are by nature hypothesis generating and should be carefully and judiciously interpreted . This need is epitomized by two of the largest review s of interventions to support risk factor reduction after a diagnosis of coronary heart disease ( Table 1 ) . These review s both included r and omized trials published in a similar timeframe ( up to 2003 or 2004 ) that compared the effects of various risk factor reduction programmes for patients with confirmed coronary heart disease to usual care . In 2004 , a Cochrane review found that supervised and unsupervised exercise-based cardiac rehabilitation provided to patients with different forms of coronary heart disease lowered all cause total mortality by 20 % and cardiac mortality by 26 % in 48 trials of 8940 patients . The review ers concluded that there was ‘ no difference in mortality effect between exercise-only cardiac rehabilitation and comprehensive cardiac rehabilitation , or by exercise dose or duration of followup ’ . Also , the exercise-based programmes did not reduce recurrent myocardial infa rct ion and the need for repeat coronary revascularization to statistically significant levels . Around the same time , a second review of 63 trials involving 21,295 patients who had undergone secondary cardiac prevention programmes found reductions of total mortality of 15 % and of acute myocardial infa rct ion of 17 % . However , in contrast to the previous review , the secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Also , benefits did not differ between programmes ‘ that incorporated education and counselling about coronary risk factors with a supervised exercise programme , those that included risk factor education or counselling but no exercise component , and those that consisted of only a structured exercise programme ’ . On first reading , these review s appear to offer different conclusions on effects on cardiovascular morbidity and regarding the benefits of supervised exercise . Either could be cited selectively to support or refute the benefits of exercise programmes for morbidity or to support or refute the incorporation of supervised exercise into services . Why might these different conclusions have come about and how should they be interpreted ? Firstly , it is unlikely that the different conclusions arise from differences in quality as both review s were of high quality as defined by PRISMA criteria and included many of the same trials : 37 of the 48 ( 77 % ) exercise-based trials were included in the 63 ( 59 % ) secondary prevention trials . Rather , issues of statistical power can explain the differences noted in morbidity . The forest plot analyses showed that , although exercise-based programmes in the Cochrane review did not reach statistically significant headline ‘ effect sizes ’ , there was a tendency towards reduced recurrent myocardial infa rct ion and the need for repeat coronary revascularization . The larger review of secondary prevention programmes considered over twice the number of events in the analysis of recurrent myocardial infa rct ion and found that secondary prevention programmes significantly reduced the rate of recurrent heart attacks . Hence , focusing only on the presence or absence of Objective : To determine if a disease management programme for patients with coronary heart disease and heart failure represents an efficient use of health services re sources . Methods : We carried out an economic evaluation alongside a cluster r and omised control trial of 1163 patients with coronary heart disease and chronic heart failure in 20 primary care practice s in the United Kingdom . Practice s were r and omised to either a control group , where patients received st and ard general practice care , or an intervention group where patients had access to a specialist nurse-led disease management programme . We estimated costs in both groups for coronary heart disease-related re source use . The main outcome measure used in the economic evaluation was quality adjusted life years ( QALY ) measured using the EuroQol . Results : The disease management programme was associated with an increase in the QALY measured of 0.03 per year and an increase in the total NHS costs of £ 425 ( € 540 ) , of this only £ 83 was directly associated with the provision of the nurse clinics . The clinics generated additional QALY at an incremental cost of £ 13 158 per QALY compared to the control group . Conclusions : The use of a nurse-led disease management programme is associated with increased costs in other coronary heart disease-related services as well as for the costs of the clinics . They are also associated with improvements in health . Even in the short term these disease management programmes may represent a cost-effective service , as additional QALY are generated at an acceptable extra cost OBJECTIVE To evaluate differences between adults who participated in a secondary prevention of ischaemic heart disease ( IHD ) programme and those who did not . DESIGN Population -based cohort study . SETTING A r and om selection of 12 Irish general practice s. PARTICIPANTS A total of 493 adults with IHD identified in 2000/2001 . INTERVENTION Medical records search and postal question naires in 2000/2001 and 2005/2006 . MAIN OUTCOME MEASURES Differences in demographic characteristics and indicators of process of care and risk factor management between participants and non- participants . RESULTS Multiple logistic regression confirmed that female gender was associated with a reduced likelihood of participation in the secondary prevention programme [ odds ratio ( OR ) 0.53 ( 95 % CI : 0.32 - 0.87 ) ] , while an adequately controlled total cholesterol level was associated with an increased likelihood of enrollment [ OR 1.82 ( 95 % CI : 1.18 - 2.80 ) ] . CONCLUSIONS There is limited evidence that biases , which have been shown to affect participation in research , also affect participation in care programmes in everyday practice . A gender bias appears to have affected the enrollment of participants for the secondary preventive programme considered by this study , with enrollment favouring men with well-managed cholesterol . Reimbursement dependent upon patient adherence may incentivise the enrollment of adherent patients , although the influence of patient choice is unclear : the need to maintain records relating to patients who opt out of such interventions is thus highlighted BACKGROUND AND AIM  Secondary prevention  after an acute coronary syndrome ( ACS ) has proved to be effective in patients with coronary heart disease , and is strongly recommended by the international guidelines . However , there is a lack of widespread secondary preventive programmes in real-world clinical practice , even though it has been shown that these can be successfully conducted by nurses . METHOD AND RESULTS We have design ed a multicentre r and omised trial involving patients with ACS in which nurses will fully coordinate secondary prevention  in the intervention arm using a multidimensional nursing form after attending ad hoc teaching sessions Aims : To evaluate the effect of a disease management programme for patients with coronary heart disease ( CHD ) and chronic heart failure ( CHF ) in primary care . Methods : A cluster r and omised controlled trial of 1316 patients with CHD and CHF from 20 primary care practice s in the UK was carried out . Care in the intervention practice s was delivered by specialist nurses trained in the management of patients with CHD and CHF . Usual care was delivered by the primary healthcare team in the control practice s. Results : At follow up , significantly more patients with a history of myocardial infa rct ion in the intervention group were prescribed a beta-blocker compared to the control group ( adjusted OR 1.43 , 95 % CI 1.19 to 1.99 ) . Significantly more patients with CHD in the intervention group had adequate management of their blood pressure ( < 140/85 mm Hg ) ( OR 1.61 , 95 % CI 1.22 to 2.13 ) and their cholesterol ( < 5 mmol/l ) ( OR 1.58 , 95 % CI 1.05 to 2.37 ) compared to those in the control group . Significantly more patients with an unconfirmed diagnosis of CHF had a diagnosis of left ventricular systolic dysfunction confirmed ( OR 4.69 , 95 % CI 1.88 to 11.66 ) or excluded ( OR 3.80 , 95 % CI 1.50 to 9.64 ) in the intervention group compared to the control group . There were significant improvements in some quality -of-life measures in patients with CHD in the intervention group . Conclusions : Disease management programmes can lead to improvements in the care of patients with CHD and presumed CHF in primary care Abstract Background Coronary heart disease ( CHD ) is the most prevalent type of cardiac disease among adults worldwide , including those in Singapore . Most of its risk factors , such as smoking , physical inactivity and high blood pressure , are preventable . mHealth has improved in the last decade , showing promising results in chronic disease prevention and health promotion worldwide . Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention ( SBCHDP ) programme in improving awareness and knowledge of CHD , perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore . Methods The smartphone app “ Care4Heart ” was developed as the main component of the programme . App content was review ed and vali date d by a panel of experts , including two cardiologists and two experienced cardiology-trained nurses . A pilot r and omised controlled trial was conducted . Eighty working people were recruited and r and omised to either the intervention group ( n = 40 ) or the control group ( n = 40 ) . The intervention group underwent a 4-week SBCHDP programme , whereas the control group were offered health promotion websites only . The participants ’ CHD knowledge , perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Question naire-2 , Perceived Stress Scale , and Behavioural Risk Factor Surveillance System . Results After the SBCHDP programme , participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore ( X2 = 6.486 , p = 0.039 ) , a better overall CHD knowledge level ( t = 3.171 , p = 0.002 ) , and better behaviour concerning blood cholesterol control ( X2 = 4.54 , p = 0.033 ) than participants in the control group . Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population . Due to the small sample size and short follow-up period , this study was underpowered to detect significant differences between groups . A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme Background The aim of the SPHERE study is to design , implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease ( CHD ) in general practice across two different health systems on the isl and of Irel and .CHD is a common cause of death and a significant cause of morbidity in Irel and . Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives . Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the isl and of Irel and . The review literature recommends structured programmes with continued support and follow-up of patients ; the provision of training , tailored to practice needs of access to evidence of effectiveness of secondary prevention ; structured recall programmes that also take account of individual practice needs ; and patient-centred consultations accompanied by attention to disease management guidelines . Methods SPHERE is a cluster r and omised controlled trial , with practice -level r and omisation to intervention and control groups , recruiting 960 patients from 48 practice s in three study centres ( Belfast , Dublin and Galway ) . Primary outcomes are blood pressure , total cholesterol , physical and mental health status ( SF-12 ) and hospital re-admissions . The intervention takes place over two years and data is collected at baseline , one-year and two-year follow-up . Data is obtained from medical charts , consultations with practitioners , and patient postal question naires . The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice . It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients . General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD . Patients are invited to attend regular four-monthly consultations over two years , during which targets and goals for secondary prevention are set and review ed . The analysis will be strengthened by economic , policy and qualitative components BACKGROUND Our aim was to investigate whether a nurse-coordinated multidisciplinary , family-based preventive cardiology programme could improve st and ards of preventive care in routine clinical practice . METHODS In a matched , cluster-r and omised , controlled trial in eight European countries , six pairs of hospitals and six pairs of general practice s were assigned to an intervention programme ( INT ) or usual care ( UC ) for patients with coronary heart disease or those at high risk of developing cardiovascular disease . The primary endpoints-measured at 1 year-were family-based lifestyle change ; management of blood pressure , lipids , and blood glucose to target concentrations ; and prescription of cardioprotective drugs . Analysis was by intention to treat . The trial is registered as IS RCT N 71715857 . FINDINGS 1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC , respectively . In patients with coronary heart disease who smoked in the month before the event , 136 ( 58 % ) in the INT and 154 ( 47 % ) in the UC groups did not smoke 1 year afterwards ( difference in change 10.4 % , 95 % CI -0.3 to 21.2 , p=0.06 ) . Reduced consumption of saturated fat ( 196 [ 55 % ] vs 168 [ 40 % ] ; 17.3 % , 6.4 to 28.2 , p=0.009 ) , and increased consumption of fruit and vegetables  ( 680 [ 72 % ] vs 349 [ 35 % ] ; 37.3 % , 18.1 to 56.5 , p=0.004 ) , and  oily fish  ( 156 [ 17 % ] vs 81 [ 8 % ] ; 8.9 % , 0.3 to 17.5 , p=0.04 ) at 1 year were greatest in the INT group . High-risk individuals and partners showed changes only for fruit and vegetables ( p=0.005 ) . Blood-pressure target of less than 140/90 mm Hg was attained by both coronary ( 615 [ 65 % ] vs 547 [ 55 % ] ; 10.4 % , 0.6 to 20.2 , p=0.04 ) and high-risk ( 586 [ 58 % ] vs 407 [ 41 % ] ; 16.9 % , 2.0 to 31.8 , p=0.03 ) patients in the INT groups . Achievement of total cholesterol of less than 5 mmol/L did not differ between groups , but in high-risk patients the difference in change from baseline to 1 year was 12.7 % ( 2.4 to 23.0 , p=0.02 ) in favour of INT . In the hospital group , prescriptions for statins  were higher in the INT group ( 810 [ 86 % ] vs 794 [ 80 % ] ; 6.0 % , -0.5 to 11.5 , p=0.04 ) . In general practice s in the intervention groups ,  angiotensin-converting enzyme inhibitors  ( 297 [ 29 % ] INT vs 196 [ 20 % ] UC ; 8.5 % , 1.8 to 15.2 , p=0.02 ) and  statins  ( 381 [ 37 % ] INT vs 232 [ 22 % ] UC ; 14.6 % , 2.5 to 26.7 , p=0.03 ) were more frequently prescribed . INTERPRETATION To achieve the potential for cardiovascular prevention , we need local preventive cardiology programmes adapted to individual countries , which are accessible by all hospitals and general practice s caring for coronary and high-risk patients OBJECTIVE : To examine the ability of a secondary prevention programme to improve the lifestyle in myocardial infa rct ion patients aged 50 - 70 years . DESIGN : Habitual physical activity , food habits , and smoking habits were assessed from question naires at admission to hospital and at the one year follow up . Initially , all patients were invited to join an exercise programme and were informed about cardiovascular risk factors . Four weeks after discharge from the hospital , 87 patients were r and omised to follow up at the coronary prevention unit by a special trained nurse ( the intervention group )  , and 81 to follow up by their general practitioners (  the  usual care group ) . After r and omisation , the intervention group was educated about the effects of smoking cessation , dietary management , and regular physical activity . The intervention group also participated in a physical training programme two to three times weekly for 10 - 12 weeks . MAIN RESULTS : 89 % of the patients referred to the intervention group improved their food habits compared with 62 % of the patients referred to the usual care group ( P = 0.008 ) . Furthermore , 50 % of the smokers referred to the intervention group stopped smoking compared to 29 % in the usual care group ( P = 0.09 ) . Changes in physical activity did not differ between the groups . CONCLUSIONS : This secondary prevention programme based on a nurse rehabilitator was successful in improving food habits in patients with acute myocardial infa rct ion . Initiating the smoking cessation programme during the hospital stay followed by repeated counselling during follow up might have improved the results . The exercise programme had no advantage in supporting physical activity compared to usual care AIM The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu , China . BACKGROUND Epidemiological studies indicate a dose- , level- and duration -dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality . Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes . DESIGN METHODS A r and omized controlled trial was conducted . Coronary heart disease patients ( n = 167 ) who met the sampling criteria in two tertiary medical centres in Chengdu , south-west China , were r and omly assigned to either an intervention group ( the cardiac rehabilitation programme ) or control group ( the routine care ) . The change of health behaviours ( walking performance , step II diet adherence , medication adherence , smoking cessation ) and physiological risk parameters ( serum lipids , blood pressure , body weight ) were assessed to evaluate the programme effect . RESULTS Patients in the intervention group demonstrated a significantly better performance in walking , step II diet adherence , medication adherence ; a significantly greater reduction in serum lipids including triglyceride , total cholesterol , low-density lipoprotein ; and significantly better control of systolic and diastolic blood pressure at three months . The majority of these positive impacts were maintained at six months . The effect of the programme on smoking cessation , body weight , serum high-density lipoprotein , was not confirmed . CONCLUSIONS A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients . Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease . RELEVANCE TO CLINICAL PRACTICE This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients . Furthermore , the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care Objective To quantify the impact of a practical , hospital-based nurse-coordinated prevention programme on cardiovascular risk , integrated into the routine clinical care of patients discharged after an acute coronary syndrome , as compared with usual care only . Design RESPONSE ( R and omised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists ) was a r and omised clinical trial . Setting Multicentre trial in secondary and tertiary healthcare setting s. Participants 754 patients admitted for acute coronary syndrome . Intervention A nurse-coordinated prevention programme , consisting of four outpatient nurse clinic visits , focusing on healthy lifestyles , biometric risk factors and medication adherence , in addition to usual care . Main outcome measures The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up . Secondary outcomes included Framingham Coronary Risk Score at 12 months , in addition to changes in individual risk factors . Risk factor control was classified as ‘ poor ’ if 0 to 3 factors were on target , ‘ fair ’ if 4 to 6 factors were on target , and ‘ good ’ if 7 to 9 were on target . Results The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent ( SD 4.5 ) in the intervention group and 5.4 per cent ( SD 6.2 ) in the control group ( p=0.021 ) , representing a 17.4 % relative risk reduction . At 12 months , risk factor control classified as ‘ good ’ was achieved in 35 % of patients in the intervention group compared with 25 % in the control group ( p=0.003 ) . Attendance to the nurse-coordinated prevention programme was 92 % . In the intervention group , 86 rehospitalisations were observed against 132 in the control group ( relative risk reduction 34.8 % , p=0.023 ) . Conclusions The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical , yet effective method for reduction of cardiovascular risk in patients with coronary disease . Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions . Trial Registration trialregister.nl Identifier TC1290 BACKGROUND The long-term effects of disease management programmes for coronary heart disease on health status are unknown . In a r and omized trial of nurse-led secondary prevention clinics , we found significantly improved health status at 1 year . Participants were followed-up again at 4 years to determine if improvements had been sustained . OBJECTIVE Our aim was to evaluate the effects on health of  nurse-led clinics for the secondary prevention of coronary heart disease in primary care . METHODS A total of 1343 patients with coronary heart disease were r and omized to nurse-led secondary prevention clinics or usual care  , with follow-up at 1 and 4 years by review of medical case notes and national data sets , and postal question naires . The study involved a stratified , r and om sample of 19 general practice s in north-east Scotl and .  Health status was measured by the SF-36 question naire , chest pain by the angina TyPE specification and anxiety and depression by the hospital anxiety and depression scale . RESULTS At 1 year , there were significant improvements in five of eight SF-36 domains ( all functioning scales , pain and general health ) in patients r and omized to clinics . Role limitations attributed to physical problems improved the most [ adjusted difference 8.52 , 95 % confidence interval ( CI ) 4.16 - 12.9 ] . At 4 years , the intervention group scored higher than control in all domains , but differences were no longer significant . At 1 year , fewer patients in the intervention group reported worsening chest pain ( odds ratio 0.59 , 95 % C1 0.37 - 0.94 ) . At 4 years , there were no significant differences between the proportion of intervention or control group patients who reported chest pain in the last week or who reported worsening chest pain . No significant effects were observed on anxiety or depression at 1 or 4 years . CONCLUSION We have demonstrated previously a significantly greater survival in attendees at nurse-led secondary prevention clinics . Despite this , improvements in health status achieved in the first year of the study were reduced at 4 years . The case for nurse-led clinics remains strong , but further research is required on ways to optimize current health status Background The study was design ed to determine whether a 1-year hospital-based secondary prevention programme would have any long-term effects on serum lipid levels and the use of lipid-lowering drugs in patients with coronary artery disease 4 years after referral to primary care facilities for follow-up . Design / methods After acute myocardial infa rct ion or coronary bypass surgery , 241 consecutive patients were r and omly assigned to conventional care ( CC ) by the primary health care facilities or to a 1-year hospital-based secondary prevention programme ( SPP ) with target levels for serum cholesterol ( < 5.2 mmol/l ) and triglycerides ( < 1.5 mmol/l ) . After 1 year all patients were referred to the primary care sector for a further 4-year follow-up . Results At the 1-year follow-up there was a significant decrease in serum cholesterol , LDL-cholesterol and triglyceride levels in the SPP group but no change in the CC group , and lipid-lowering drugs were used more frequently in the SPP group . These changes were maintained after 5 years . The proportion of patients achieving target serum cholesterol and triglyceride levels were larger in the SPP group . Conclusions Initiatives regarding cholesterol lowering and drug treatment taken by specialists within a structured hospital-based SPP have long-term impact . Accordingly , drug treatment should be initiated and adjusted to adequate doses before patients are referred to primary care for follow-up Effects of a post-hospitolization group health education programme for patients with coronary heart disease . A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital . A r and omized pre-test post-test control group design was used to evaluate the effects of this experimental intervention . The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to st and ard medical care and physical training . A control group of 108 patients received only st and ard medical care and physical training .  The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session . All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident . In the short term ( about four months after the incident ) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases , smoking cessation , healthy eating habits and the number of consultations with the family physician , but no effects on emotional distress . In the long term ( one year after the incident ) there was only a significant intervention effect on smoking cessation . These results suggest that the effects of the programme are modest , especially in terms of maintenance of behavioural change . As a consequence , it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation , but only to those who can be expected to profit most from it AIMS Cardiac rehabilitation including exercise training is of proven value in ischaemic heart disease . However , elderly patients frequently are not encouraged to participate in such programmes . This study evaluates the physiological effects and self-reported quality of life after an aerobic outpatient group-training programme in subjects above the age of 65 years . METHODS AND RESULTS A consecutive series of 101 patients ( males 80 % ) aged 65 - 84 ( mean 71 ) years recovering from an acute coronary event were r and omized to either a supervised out patient group-training programme ( n=50 ) or to a control group ( n=51 ) . The two groups were well balanced as regards clinical characteristics . The compliance in the training group was 87 % . Exercise tolerance increased in the trained group from 104 to 122 and 111 W after 3 and 12 months respectively . The corresponding values were 102 , 105 and 105 W among controls . Parameters , such as quality of life , self-estimated level of physical activity , fitness and well-being were grade d higher by the trained patients than those who served as controls on the two occasions of follow-up . CONCLUSIONS Aerobic group-training of elderly patients recovering from an acute coronary event beneficially influences physical fitness and several parameters expressing quality of life . Great care has to be taken to preserve the initial effects by continued training Background Coronary heart disease as well as major cardiovascular risk factors are associated with elevated levels of proinflammatory markers . There is , however , limited information about how changes in lifestyle improving the cardiovascular risk profile influence these levels . The aim of the study was to evaluate whether changes in lifestyle measures with special attention to physical activity , were associated with the levels of such markers . Design Coronary heart disease patients ( n = 197 ) were r and omized to either a comprehensive lifestyle intervention programme comprising regular physical activity , low fat diet and smoking cessation , or usual care with routine follow-up in the outpatient clinic for 6 months . An exercise test and fasting blood sample s analysed for soluble cell adhesion molecules , C reactive protein and pro-inflammatory cytokines were evaluated before and at the end of the study . Results Improved diet , physical performance and reduction in smoking were obtained in the intervention programme when compared with usual care patients , but no significant group differences in levels of inflammatory markers were observed . In the total population , however , physical performance significantly and inversely predicted levels of soluble cell adhesion molecule 1 , ( P>0.001 ) , C-reactive protein ( P>0.001 ) and interleukin-6 ( P=0.01 ) at 6 months . Smokers had elevated levels of soluble cell adhesion molecule 1 when compared with non-smokers ( P=0.011 ) . Conclusions We demonstrated that physical performance is inversely correlated with levels of pro-inflammatory markers in coronary heart disease patients , possibly retarding the process of atherosclerosis . No effect on inflammatory markers was obtained with a 6-month lifestyle intervention programme when compared with patients who received usual care follow-up . Eur J Cardiovasc Prev Rehabil 13:356 - 362 © 2006 The European Society of Background Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease . The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear , as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function . In this study a comprehensive school-based r and omized intervention programme will be investigated in 10 - 14-year old children addressing the influence of lifestyle intervention on inactivity , cardiometabolic risk factors and early signs of vascular disease . Methods / Design 15 secondary schools in Southern Germany are r and omly assigned to intervention or control schools . Children in the fifth grade ( 10 - 11 years ) will be observed over four years . The study combines a school-based with a home-based approach , aim ing at children , teachers and parents . The main components are weekly lifestyle-lessons for children , taught by regular classroom teachers to increase physical activity in- and outside of school , to improve eating patterns at school and at home , to reduce media consumption and to amplify well-being . In 4 - 6 annual meetings , teachers receive information about health-related topics with worksheets for children and supporting equipment , accounting for school-specific needs and strategies . Parents ' trainings are provided on a regular basis . All examinations are performed at the beginning and at the end of every school year . Anthropometry includes measurements of BMI , waist and upper arm circumferences , skinfold thickness as well as peripheral blood pressure . Blood sampling includes lipid parameters , insulin , glucose , hsCRP , adiponectin , and IL-6 as well as testosteron and estrogen to determine maturation status . Vascular function is non-invasively assessed by measuring arterial stiffness in large arteries using a sphygmograph and by analysing arteriolar and venular diameters in the retinal microcirculation using a non-mydriatric vessel analyser . A question naire is filled out to determine daily physical activity , motivational factors , dietary habits , quality of life ( KINDL-R ) and socio-economic data . Physical fitness is assessed by a six-item test battery . Discussion Our study aims to provide a feasible long-term intervention strategy to re-establish childhood health and to prevent obesity-related cardiovascular dysfunction in children . Trial Registration We sent a short postal question naire to 244 centres in Engl and and Wales that admitted patients with cardiac conditions . In total , 199 ( 81 % ) of the centres cl aim ed to provide a  cardiac rehabilitation service .  Of these , 25 were r and omly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services . Most ( 18 ( 72 % ) ) of the centres had commenced their rehabilitation programme within the previous 5 years , usually at the instigation of interested staff . Patient entry to cardiac rehabilitation programmes was restricted ; women ( who represented only 15 % of attenders ) , elderly people ( excluded in 10 ( 40 % ) centres ) , and those with more complex problems , such as angina or heart failure , were under-represented . The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision . Most ( 22 ( 88 % ) ) programmes were hospital out-patient based , one ( 4 % ) was hospital in-patient based , one ( 4 % ) was community-based and one ( 4 % ) was home-based . The staffing and funding of programmes was variable , with 7 ( 28 % ) having no identified funding . There are wide variations in the re sources currently available for the rehabilitation of patients with coronary heart disease . There is a need for clearer direction of these services , in particular to determine minimum service provision . Guidelines are necessary to give a framework for this relatively new and rapidly exp and ing service Background Coronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide . Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain . In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease , however it is unclear how general practitioners should manage these patients . We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression . Methods / design This programme of research will consist of 4 inter-related studies . A 4 year prospect i ve cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression . Within this , a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample . Two qualitative studies , one of patients ' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals ' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group . A feasibility study for a r and omised controlled trial will then be conducted . Discussion This study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group . The results of the cohort study will also provide information on risk factors for depression . The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a definitive r and omised controlled trial of the intervention OBJECTIVES To assess the efficacy of a comprehensive secondary prevention programme to reduce morbidity and mortality in patients who have suffered a cardiovascular ( CV ) event ; to control CV risk factors and prophylactic treatment in order to prevent recurrence ; and to improve the quality of life of patients with cardiovascular disease . DESIGN R and omised , pragmatic , open clinical trial in primary care . SETTING A total of 42 primary care centres of 8 different areas in Spain . PARTICIPANTS Men and women below 86 years old , diagnosed with coronary disease and /or stroke and /or peripheral vascular disease in the preceding year , and who have no serious or terminal disease . INTERVENTION Primary care centres will be r and omised to following usual care ( control group ) , or to following a comprehensive programme of secondary prevention ( intervention group ) . MAIN MEASUREMENTS Cardiovascular fatal events , cardiovascular non-fatal events , total mortality and health-related quality of life ( SF-36 ) Abstract Objectives : To evaluate the effects of nurse led clinics in primary care on secondary prevention , total mortality , and coronary event rates after four years . Design : Follow up of a r and omised controlled trial by postal question naires and review of case notes and national data sets . Setting : Stratified , r and om sample of 19 general practice s in north east Scotl and . Participants : 1343 patients ( 673 intervention and 670 control ) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound . Intervention : Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year . Main outcome measures : Components of secondary prevention ( aspirin , blood pressure management , lipid management , healthy diet , exercise , non-smoking ) , total mortality , and coronary events ( non-fatal myocardial infa rct ions and coronary deaths ) . Results : Mean follow up was at 4.7 years . Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year , and these were sustained after four years except for exercise . The control group , most of whom attended clinics after the initial year , caught up before final follow up , and differences between groups were no longer significant . At 4.7 years , 100 patients in the intervention group and 128 in the control group had died : cumulative death rates were 14.5 % and 18.9 % , respectively ( P=0.038 ) . 100 coronary events occurred in the intervention group and 125 in the control group : cumulative event rates were 14.2 % and 18.2 % , respectively ( P=0.052 ) . Adjusting for age , sex , general practice , and baseline secondary prevention , proportional hazard ratios were 0.75 for all deaths ( 95 % confidence intervals 0.58 to 0.98 ; P=0.036 ) and 0.76 for coronary events ( 0.58 to 1.00 ; P=0.049 ) Conclusions : Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events .  Secondary prevention clinics should be started sooner rather than later . What is already known on this topic Several effective interventions exist for the secondary prevention of coronary heart disease , but implementing them in practice has proved difficult Secondary prevention programmes for coronary heart disease have improved short term outcomes such as processes of care and quality of life What this study adds Short term improvements in uptake of secondary prevention produced by nurse led clinics are maintained in the longer term Improved medical and lifestyle components of secondary prevention produced by nurse led clinics seem to lead to fewer total deaths and coronary AIMS To investigate the long-term benefits of a six-week comprehensive cardiac rehabilitation programme on physical activity , psychological well-being and quality of life in patients with coronary heart disease . BACKGROUND Cardiac rehabilitation ( CR ) in short term improves exercise capacity and quality of life in patients with cardiac disease . However , the long-term benefits of CR are inconclusive . DESIGN A prospect i ve CR programme with repeated measures follow-up over 12 months . METHODS A six-week outpatient cardiac rehabilitation programme  was conducted including 147 patients with coronary heart disease . Patients completed the  physical activity energy expenditure ( seven-day recall activity ) , MacNew Heart Disease Health-Related Quality of Life ( MacNew ) and Hospital Anxiety and Depression scale ( HADs ) at baseline , six weeks , six and 12 months . RESULTS One hundred and five ( 71 % ) patients ( 76 male ) mean age of 61.8 ( SD 9.7 ) completed the four-measurement points . Analysis of variance revealed that total energy expenditure ( F ( 2 , 231 ) = 131 , p < 0.001 ) , HADs ( F ( 2 , 237 ) = 19.3 , p < 0.001 ) , depression score ( F ( 2 , 235 ) = 21.06 , p < 0.001 ) , anxiety score ( F ( 2,237 ) = 17.02 , p < 0.001 ) and MacNew ( F ( 2 , 197 ) = 77.02 , p < 0.001 ) were all statistically significant over time . Bonferroni pairwise follow-up confirmed significant positive differences ( p < 0.05 ) between baseline values and all subsequent measures over time . Depression was independently explained in 22 % of the variance in quality of life at 6 or 12 months . The energy expenditure was significantly higher for men compared to women ( F ( 1 , 103 ) = 31 , p < 0.001 ) . CONCLUSION A six-week cardiac rehabilitation programme is beneficial in improving quality of life , physical activity status , anxiety and depression . These benefits were maintained at 12 months . Elevated levels of depression were associated with impaired quality of life . RELEVANCE TO CLINICAL PRACTICE All relevant health care staff should be aware of the benefits of CR and routinely refer and encourage patients with cardiac disease to attend a cardiac rehabilitation programme . Depression and anxiety intervention strategies should be incorporated in cardiac rehabilitation programmes Twenty-four factories or other occupational groups , employing 18 210 men aged 40 to 59 , were formed into matched pairs . One of each pair was allocated r and omly to receive a five to six year programme of medical examinations and intervention to reduce the levels of the main coronary risk factors . Men at factories in the intervention group were given advice on dietary reduction of plasma cholesterol concentrations , stopping or reducing cigarette smoking , regular exercies for the sedentary and reduced energy intake for the overweight , and hypertension was treated . The programme was delivered mainly through existing occupational medical services , helped by a small central staff . Personal consultations were largely confined to men with a high risk of developing coronary heart disease . Changes in risk factors were assessed by regular st and ardised examinations of r and om sample s of men . The spread of information by general propag and a proved easy , but a change in habits seemed to require personal contact . Small but significant reductions occurred , mainly in the high-risk group , but these were not sustained when pressure was relaxed BACKGROUND Exercise-based cardiac rehabilitation is considered an important adjunct treatment and secondary prevention measure in patients with coronary artery disease ( CAD ) . However , the issues of training modality and exercise intensity for CAD patients remain controversial . OBJECTIVE Main aim of the present study is to test the hypothesis that aerobic interval training ( AIT ) yields a larger gain in peak aerobic capacity ( peakVO2 ) compared to a similar training programme of moderate continuous training ( MCT ) in CAD patients . STUDY DESIGN In this multicentre study stable CAD patients with left ventricular ejection fraction>40 % will be r and omized after recent myocardial infa rct ion or revascularization ( PCI or CABG ) to a supervised 12-week programme of three weekly sessions of either AIT ( 85 - 90 % of peak oxygen uptake [ peakVO2 ] , 90 - 95 % of peak heart rate ) or MCT ( 60 - 70 % of peakVO2 , 65 - 75 % of peak heart rate ) . The primary endpoint of the study is the change of peakVO2 after 12 weeks training . Secondary endpoints include safety , changes in peripheral endothelial vascular function , the evolution of traditional cardiovascular risk factors , quality of life and the number and function of circulating endothelial progenitor cells as well as endothelial microparticles . Possible differences in terms of long-term adherence to prescribed exercise regimens will be assessed by regular physical activity question naires , accelerometry and re assessment of peakVO2 12 months after r and omization . A total number of 200 patients will be r and omized in a 1:1 manner ( significance level of 0.05 and statistical power of 0.90 ) . Enrolment started December 2010 ; last enrolment is expected for February 2013 The Recurrent Coronary Prevention Project ( RCPP ) was established as a 5-year clinical trial to examine two basic questions : --1 . Can the recurrence rate of post-coronary subjects be substantially reduced over a 5-year period by means of a programme of behavioural change , in comparison with treatment by cardiologists focussing on medication , diet , exercise and cardiovascular issues , and with subjects who only receive regular care from their own physician ? 2 . Can the Type A behaviour pattern ( TABP ) be changed and do such changes correspond to reduced recurrences of coronary heart disease ( CHD ) over a 5 year period ? To answer these questions , four major treatment groups are currently being compared : --1 . A small group treatment programme ( Section I ) led by cardiologists emphasizing adherence to medication , diet and exercise , and giving cardiovascular and cardiological information . 2 . A behavioural change treatment programme ( Section II ) based primarily on a cognitive social learning model and attempting to alter TABP . 3 . A control group of subjects assessed annually and receiving private medical care from their own physicians . 4 . A dropout comparison group composed of subjects voluntarily discontinuing participation in groups led by cardiologists or in behavioural change groups . Results to date show a significantly reduced rate of recurrence for subjects in the behavioural change group , compared to those in the groups led by cardiologists as well as control and dropout groups . These significantly lower recurrence rates are accompanied by data suggesting that subjects in the behavioural change programme are also altering their TABP as measured by both behavioural question naires and videotaped Type A structured interviews . Clinical impressions suggest that treatment programmes to alter TABP should consider the primary importance of the personal meaning of the TABP and other behaviours to the individual concerned , particularly how basic underlying beliefs set the stage for the TABP . The central role of hostility as a pervasive orientation towards self and others is emphasized , as are issues of excessive controllability related to extreme competitiveness and hyper-arousal . The multiple roles of group leaders , especially as social models for coping , and the impact of the small groups setting s , is also discussed Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 The paper provides the results obtained in the course of the cooperative All-Union programme on multifactor prevention of coronary heart disease ( CHD ) , which has been implemented over 3 years to examine the efficiency of preventive actions aim ed at correcting the levels of CHD risk factors . The study was conducted in 6 centers of the country among a non-organized male population aged 40 - 59 years . The outcome of the preventive measures , largely nonpharmacological ones , made during 3 years suggests that the prevalence of the major CHD risk factors may be reduced in the population . The preventive actions are the most beneficial in arterial hypertension and smoking Aim Multidisciplinary disease management programmes ( MDPs ) for heart failure have been shown to be effective in Western countries . However , it is not known whether they improve outcomes in a high population density country with a national health insurance programme . Methods In total , 349 patients hospitalized because of heart failure were r and omized into  control  and MDP groups . All-cause death and re-hospitalization related to heart failure were analyzed . The median follow-up period was approximately 2 years . Results Mean patient age was 60 years ; 31 % were women ; and 50 % of patients had coronary artery disease . MDP was associated with fewer all-cause deaths [ hazard ratio ( HR ) = 0.49 , 95 % confidence interval ( CI ) = 0.27–0.91 , P = 0.02 ] and heart failure-related re-hospitalizations ( HR = 0.44 , 95 % CI = 0.25–0.77 , P = 0.004 ) . MDP was still associated with better outcomes for all-cause death ( HR = 0.53 , 95 % CI = 0.29–0.98 , P = 0.04 ) and heart failure-related re-hospitalization ( HR = 0.46 , 95 % CI = 0.26–0.81 , P = 0.007 ) , after adjusting for age , diuretics , diabetes mellitus , chronic kidney disease , hypertension , sodium , and albumin . However , MDPs ’ effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or & bgr;-blockers . A stratified analysis showed that MDP combined with guideline -based medication had synergistic effects . Conclusions MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme . MDP synergistically improves the effectiveness of guidelines -based medications for heart failure AIMS This paper reports a study examining the quality of life of clients following hospital admission with acute coronary syndrome in Hong Kong and their use of cardiac rehabilitation . BACKGROUND Coronary heart disease is a major source of mortality and morbidity in Hong Kong . Western studies have suggested that participation in cardiac rehabilitation improves the quality of life of clients with coronary heart disease yet the use of cardiac rehabilitation has been reported to be low . Better underst and ing is needed of the psychosocial status of these clients in Hong Kong and their use of cardiac rehabilitation services . METHODS A prospect i ve , pretest-post-test study was carried out , with data collected over a period of 6 months with convenience sample of 182 participants . Baseline data were obtained within one week after hospital admission for individuals experiencing ACS . The second phase of data collection commenced at 6 months after hospital discharge . Total period of data collection took over 12 months between 2002 and 2003 . The Chinese version of the SF-36 was used to assess quality of life , and demographic data and the extent to which clients participated in the cardiac rehabilitation programme were assessed . RESULTS Only 25 % of the participants attended at least one session of the cardiac rehabilitation programme . Significant improvement occurred in all clients ' perceived quality of life 6 months following initial hospital admission . No significant group differences in perceived quality of life were found according to whether or not clients used the cardiac rehabilitation services . CONCLUSION Improvement in perceived health-related quality of life was evident over a 6-month period . Yet our findings suggested that participation in the cardiac rehabilitation programme did not have any apparent effects in subjects ' perceived quality of life . Further studies using both generic and disease-specific health-related quality of life instruments , as well as the inclusion of control group , are recommended . Continual improvement in cardiac rehabilitation programmes , and consideration of alternative modes of delivery other than the traditional attendance at hospital outpatient services , are also recommended Predictability of the psychic outcome for two cardiac rehabilitation programmes was investigated in 119 myocardial infa rct ion patients . They were r and omly assigned to either a five-week daily exercise training or to an identical training in combination with six sessions of relaxation therapy , individually . The psychic outcome was constructed as a composite measure of change on six psychological question naires . The aim was to determine the predictive qualities of base-line : ( 1 ) clinical data ; ( 2 ) exercise testing ; ( 3 ) psychosocial information derived from interview ; and ( 4 ) vali date d psychological question naires and whether the kind of rehabilitation programme has any influence on the predictive qualities of the variables . The psychic outcome turned out to be highly predictable ( multiple correlation of 0.72 ) . Predictors of relatively high importance were age , work-status and job-level , followed by mild heart failure , diastolic blood pressure and heart rate , all of them dependent upon the kind of treatment . It implies that the type of rehabilitation programme modified the effect of the determinants of psychic outcome . This research strategy is promising and deserves to be stimulated in order to build rehabilitation programmes tailored to the needs and abilities of the individual patient Background : Little is known about statins in the prevention of  dyslipidaemia induced renal function decline . The secondary coronary heart disease ( CHD ) prevention GREACE study suggested that dose titration with atorvastatin ( 10–80 mg/day , mean dose 24 mg/day ) achieves the national cholesterol educational programme treatment goals and significantly reduces morbidity and mortality , compared with usual care . Aims : To report the effect of statin on renal function compared with untreated dyslipidaemia in both treatment groups . Methods / Results : All patients had plasma creatinine values within the reference range < 115 µmol/litre ( 13 mg/litre ) .  The on study creatinine clearance ( CrCl ) , as estimated ( for up to 48 months ) by the Cockroft-Gault formula , was compared within and between treatment groups using analysis of variance to assess differences over time . Patients from both groups not treated with statins ( 704 ) showed a 5.2 % decrease in CrCl ( p < 0.0001 ) . Usual care patients on various statins ( 97 ) had a 4.9 % increase in CrCl ( p = 0.003 ) . Structured care patients on atorvastatin ( 783 ) had a 12 % increase in CrCl ( p < 0.0001 ) . This effect was more prominent in the lower two quartiles of baseline CrCl and with higher atorvastatin doses . After adjustment for 25 predictors of all CHD related events , multivariate analysis revealed a hazards ratio of 0.84 ( confidence interval 0.73 to 0.95 ; p = 0.003 ) with every 5 % increase in CrCl . Conclusions : In untreated dyslipidaemic patients with CHD and normal renal function at baseline , CrCl declines over a period of three years . Statin treatment prevents this decline and significantly improves renal function , potentially off setting an additional factor associated with CHD risk Background : Many studies have shown that individual lifestyle factors are associated with cardiovascular mortality and all-cause mortality . Observational studies of comprehensive programmes have reported risk reductions . The objectives were to assess the long-term all-cause mortality by diagnosis in patients referred to a lifestyle modification programme  , aim ed at combating coronary heart disease and stroke . Methods : A r and omized trial with 325 patients referred to the centre between 1988 and 1989 for dyslipidemia , hypertension , type 2 diabetes and coronary heart disease ; 239 patients were r and omized to the programme , 86 r and omized to usual care . Cases were admitted to the centre in groups of 30 for a 4-week residential comprehensive activity , in total 114 full-time hours , focusing on food preferences and selection s , and physical exercise . The activities were repeated during a 4-day revisit to the centre 1 year and 5 years after the 4-week intervention . Controls were referred back to their doctors , mainly in primary care , for usual care . Main outcome measure was all-cause mortality during 11–12 and 18–19 years after intervention . Results : At follow-up 11–12 years after referral , the relative risk reduction ( RRR ) was 76 % with the intention-to-treat analysis among cases admitted for dyslipidemia ( hazards ratio 0.24 , confidence interval 0.06–0.89 , P = 0.033 ) . After 18–19 years , the RRR was 66 % ( hazards ratio 0.34 , confidence interval 0.13–0.88 , P = 0.026 ) . No RRR was found for the other three diagnoses . Conclusion : Patients admitted for dyslipidemia reached a real long-term RRR of all-cause mortality . They had by definition a need for this programme OBJECTIVES --(a ) To determine the excess mortality from all causes and from coronary heart disease in patients with familial hypercholesterolaemia ; ( b ) to examine how useful various criteria for selective measurement of cholesterol concentration in cardiovascular screening programmes are in identifying these patients . DESIGN -- Prospect i ve cohort study . SETTING --Eleven hospital outpatient lipid clinics in the United Kingdom . PATIENTS --282 men and 244 women aged 20 - 74 with heterozygous familial hypercholesterolaemia . MAIN OUTCOME MEASURE -- St and ardised mortality ratio , all adults in Engl and and Wales being taken as st and ard ( st and ardised mortality ratio = 100 for st and ard population ) . RESULTS --The cohort was followed up for 2234 person years during 1980 - 9 . Fifteen of the 24 deaths were due to coronary heart disease , giving a st and ardised mortality ratio of 386 ( 95 % confidence interval 210 to 639 ) . The excess mortality from this cause was highest at age 20 - 39 ( st and ardised mortality ratio 9686 ; 3670 to 21,800 ) and decreased significantly with age . The st and ardised mortality ratio for all causes was 183 ( 117 to 273 ) and also was highest at age 20 - 39 ( st and ardised mortality ratio 902 ; 329 to 1950 ) . There was no significant difference between men and women . Criteria for measurement of cholesterol concentration in cardiovascular screening programmes ( family history , presence of myocardial infa rct ion , angina , stroke , corneal arcus , xanthelasma , obesity , hypertension , diabetes , or any of these ) were present in 78 % of patients . CONCLUSIONS --Familial hypercholesterolaemia is associated with a substantial excess mortality from coronary heart disease in young adults but may not be associated with a substantial excess mortality in older patients . Criteria for selective measurement of cholesterol concentration in cardiovascular screening programmes identify about three quarters of patients with the clinical ly overt condition AIMS AND OBJECTIVES To investigate use of educational audiotape programme on anxiety and depression in patients undergoing coronary artery bypass graft ( CABG ) .  BACKGROUND Anxiety and depression after CABG are the most common complications , having a negative impact on the prognosis of heart disease , leading to special needs according to their new physical and mental conditions . DESIGN R and omised clinical trial . METHODS This study conducted in Iran , 70 patients undergoing CABG were included and divided into two equal groups , the control group and intervention group . They were followed up for six weeks . An audiotape educational programme was given to the intervention group after surgery in addition to the routine training . But patients in the control group received only routine training .  Anxiety and depression were assessed by Hospital Anxiety and Depression Scale , a st and ardised question naire for anxiety and depression . Data were collected before and six weeks after the intervention . For the comparison of mean scores between the groups , the data were analysed in spss , version 16 , using independent T-test and paired T-test . RESULTS The mean scores obtained in both anxiety and depression dimensions were significantly different between the intervention and control groups . CONCLUSIONS Audiotape educational programme used by patients undergoing CABG decreases the level of their anxiety and depression after cardiac surgery . RELEVANCE TO CLINICAL PRACTICE The most significant finding was the importance of audiotape educational programme to meet the needs of the CABG patients , which suggest that patient education through audiotape can be effective in self-care after heart surgery and nurses can use an audiotape containing preparatory information to improve outcomes and reduce anxiety and depression in patients having CABG Background Lack of patient involvement in decision making has been suggested as one reason for limited treatment success . Concepts such as shared decision making may contribute to high quality healthcare by supporting patients to make informed decisions together with their physicians . A multi-component shared decision making programme on the prevention of heart attack in type 2 diabetes has been developed . It aims at improving the quality of decision-making by providing evidence -based patient information , enhancing patients ’ knowledge , and supporting them to actively participate in decision-making . In this study the efficacy of the programme is evaluated in the setting of a diabetes clinic . Methods / Design A single blinded r and omised-controlled trial is conducted to compare the shared decision making programme with a control-intervention . The intervention consists of an evidence -based patient decision aid on the prevention of myocardial infa rct ion and a corresponding counselling module provided by diabetes educators . Similar in duration and structure , the control-intervention targets nutrition , sports , and stress coping .  A total of 154 patients between 40 and 69 years of age with type 2 diabetes and no previous diagnosis of ischaemic heart disease or stroke are enrolled and allocated either to the intervention or the control-intervention . Primary outcome measure is the patients ’ knowledge on benefits and harms of heart attack prevention captured by a st and ardised knowledge test . Key secondary outcome measure is the achievement of treatment goals prioritised by the individual patient . Treatment goals refer to statin taking , HbA1c- , blood pressure levels and smoking status . Outcomes are assessed directly after the counselling and at 6 months follow-up . Analyses will be carried out on intention-to-treat basis . Concurrent qualitative methods are used to explore intervention fidelity and to gain insight into implementation processes . Discussion Interventions to facilitate evidence -based shared decision making represent an innovative approach in diabetes care . The results of this study will provide information on the efficacy of such a concept in the setting of a diabetes clinic in Germany . Trial registration IS RCT OBJECTIVES To describe the effects of a health advocacy , counselling , and activation programme on depressive symptoms among older coronary heart disease ( CHD ) patients . METHODS A r and omised , controlled intervention study in Lieto , South-western Finl and . Older ( 65 years and older ) patients with CHD were r and omly divided into an intervention group ( IG ) ( n = 116 ) and a control group ( CG ) ( n = 106 ) . Outcome measures comprised changes in depressive symptoms ( Zung Self-rating Depression Scale , ZSDS ) . RESULTS Depressive symptoms tended to decrease in IG and to increase in CG among men scoring 45 ZSDS sum points or more at baseline . The differences of the changes between IG and CG were significant in favour of IG . No similar changes were found among women . CONCLUSIONS A health advocacy , counselling , and activation programme aim ed to increase knowledge about CHD , social activities , contacts , roles , support , and exercising was effective in reducing depressive symptoms among male CHD patients suffering from a moderate or high amount of depressive symptoms Objective : To determine the effect of a new CHOICE ( Choice of Health Options In prevention of Cardiovascular Events ) programme on cardiovascular risk factors in acute coronary syndrome ( ACS ) survivors . Design : Single-blind r and omised controlled trial . Setting : Tertiary referral hospital in Sydney Australia . Patients : 144 ACS survivors who were not accessing st and ard cardiac rehabilitation .  Data were also collected on a further 64 ACS survivors attending st and ard cardiac rehabilitation . Intervention : The CHOICE group ( n = 72 ) participated in a brief , patient-centred , modular programme comprising a clinic visit plus telephone support , encompassing m and atory cholesterol lowering and tailored preferential risk modification . The control group ( n = 72 ) participated in continuing conventional care but no central ly coordinated secondary prevention . Main outcome measures : Values for total cholesterol , systolic blood pressure , smoking status and physical activity . Results : CHOICE and control groups were well matched at baseline . At 12 months , the CHOICE group ( n = 67 ) had significantly better risk factor levels than controls ( n = 69 ) for total cholesterol ( TC ) ( mean ( SEM ) 4.0 ( 0.1 ) vs 4.7 ( 0.1 ) mmol/l , p<0.001 ) , systolic blood pressure ( 131.6 ( 1.8 ) vs 143.9 ( 2.3 ) mm Hg , p<0.001 ) , body mass index ( 28.9 ( 0.7 ) vs 31.2 ( 0.7 ) kg/m2 , p = 0.025 ) and physical activity ( 1369.1 ( 167.2 ) vs 715.1 ( 103.5 ) METS/kg/min , p = 0.001 ) as well as a better knowledge of risk factor targets . Also at 1 year , fewer CHOICE participants ( 21 % ) had three or more risk factors above widely recommended levels then controls ( 72 % ) ( p<0.001 ) . Conclusions : Participation in a brief CHOICE programme significantly improved the modifiable risk profiles and risk factor knowledge of ACS survivors over 12 months . CHOICE is an effective alternative for dealing with the widespread underuse of existing secondary prevention programmes . Trial registration number : IS RCT OBJECTIVE To assess the effects of a Dutch national prevention programme , aim ed at general practitioners ( GPs ) , on the adherence to organizational guidelines for effective cervical cancer screening  in general practice . To identify the characteristics of general practice s determining success . DESIGN A prospect i ve question naire study with pre- and post-measurement ( before and 15 months after the introduction of the national programme ) . SETTING AND STUDY PARTICIPANTS A r and om sample of one-third of all 4758 Dutch general practice s. One GP was asked to participate per practice . INTERVENTION A national GP prevention programme to improve population -based prevention of cervical cancer combining various methods for quality improvement in general practice , performed on a national , district and practice level . Outreach visitors were a key strategy in bringing about behavioural changes . MAIN OUTCOME MEASURES The proportion of practice s adhering to 10 recommendations ( in four guidelines ) to organize effective cervical cancer screening .  RESULTS After 15 months , all Dutch practice s showed significant improvement in adherence to nine out of 10 recommendations . Two recommendations , in particular ' identifying women who should be medically excluded from screening ' and ' sending a reminder to non-compliers ' showed the largest absolute increases of 26 % and 33 % , respectively . Besides more intensive support of outreach visitors , practice characteristics such as ' computerization ' and ' delegation of many clinical tasks to the practice assistant ' were important in improving the adherence to guidelines . CONCLUSION The national programme , with a combination of various methods for quality improvement , appeared to be effective in improving the organization of cervical screening in general practice . Computerization and , to a lesser extent , delegation of many clinical tasks to the practice assistant and more intensive support to practice s , positively influenced the effectiveness of the national programme
Other characteristics , including specialist versus generalist provision , did not appreciably impact programme effectiveness .
Conclusions Shorter secondary prevention programmes , those based in general practice , and those staffed by generalists are at least as effective in reducing all cause mortality in patients with coronary heart disease as longer programmes , hospital-based programmes , and programmes staffed by specialists
Background The aim of this study was to determine which programme characteristics influence the effectiveness of secondary prevention programmes for Coronary Heart Disease .