Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial

Harald T Jorstad, Clemens von Birgelen, A Marco W Alings, Anho Liem, Jan Melle van Dantzig, Wybren Jaarsma, Dirk J A Lok, Hans J A Kragten, Keesjan de Vries, Paul A R de Milliano, Adrie J A M Withagen, Wilma J M Scholte Op Reimer, Jan G P Tijssen, Ron J G Peters, Harald T Jorstad, Clemens von Birgelen, A Marco W Alings, Anho Liem, Jan Melle van Dantzig, Wybren Jaarsma, Dirk J A Lok, Hans J A Kragten, Keesjan de Vries, Paul A R de Milliano, Adrie J A M Withagen, Wilma J M Scholte Op Reimer, Jan G P Tijssen, Ron J G Peters

Abstract

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 (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.

Setting: Multicentre trial in secondary and tertiary healthcare settings.

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 trialregisternl identifier: TC1290.

Keywords: Coronary Artery Disease.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
SCORE cardiovascular mortality estimation. SCORE at baseline, 6 months and 12 months. Error bars show 95%-CIs. ACS=acute coronary syndrome.
Figure 3
Figure 3
Classification of achievement of risk factor targets per patient (%). Poor control is classified as 0–3 risk factors, fair control is classified as 4–6 risk factors and good control is classified as 7–9 risk factors on target. Risk factors are smoking, body-mass index

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