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

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Secondary prevention of coronary disease
Original article
Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial
  1. Harald T Jorstad1,
  2. Clemens von Birgelen2,
  3. A Marco W Alings3,
  4. Anho Liem4,
  5. Jan Melle van Dantzig5,
  6. Wybren Jaarsma6,
  7. Dirk J A Lok7,
  8. Hans J A Kragten8,
  9. Keesjan de Vries9,
  10. Paul A R de Milliano10,
  11. Adrie J A M Withagen11,
  12. Wilma J M Scholte op Reimer1,
  13. Jan G P Tijssen1,
  14. Ron J G Peters1
  1. 1Department of Cardiology, Academic Medical Center—University of Amsterdam, Amsterdam, Noord Holland, The Netherlands
  2. 2Department of Cardiology, Medisch Spectrum Twente and University of Twente, Enschede, The Netherlands
  3. 3Department of Cardiology, Amphia Hospital, Breda, The Netherlands
  4. 4Department of Cardiology, Admiraal de Ruyter Hospitals, Goes, The Netherlands
  5. 5Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
  6. 6Department of Cardiology, Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
  7. 7Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
  8. 8Department of Cardiology, Atrium Medical Center, Heerlen, The Netherlands
  9. 9Department of Cardiology, Medical Center Leeuwarden South, Leeuwarden, The Netherlands
  10. 10Department of Cardiology, Tergooi Hospitals, Hilversum, The Netherlands
  11. 11Department of Cardiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
  1. Correspondence to Harald Thune Jørstad, Department of Cardiology, Academic Medical Center—University of Amsterdam, Meibergdreef 9, P.O. Box 22660, Room F3-241, Amsterdam 1100 DD, The Netherlands; h.t.jorstad{at}amc.uva.nl

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 trialregister.nl Identifier TC1290.

  • Coronary Artery Disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

https://doi.org/10.1136/heartjnl-2013-303989

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