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Randomized Controlled Trial
. 2008 Oct;62(10):1484-98.
doi: 10.1111/j.1742-1241.2008.01872.x. Epub 2008 Aug 7.

A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile

J S Benner  1 , L Erhardt, M Flammer, R A Moller, N Rajicic, K Changela, C Yunis, S B Cherry, Z Gaciong, E S Johnson, M C J M Sturkenboom, J García-Puig, X Girerd; REACH OUT Investigators
Affiliations
Randomized Controlled Trial

A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile

J S Benner et al. Int J Clin Pract. 2008 Oct.

Abstract

Aims: We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care.

Methods: The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster-randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients' risk and provided usual care only. The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care.

Results: Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04).

Conclusions: A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice.

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Figures

Figure 1
Figure 1
Study flow diagram. KAB, Knowledge, Attitudes and Behaviour; TOC, Touch Outcomes Collector; CV, cardiovascular
Figure 2
Figure 2
Patient flow. AEs, adverse events; TOC, Touch Outcomes Collector
Figure 3
Figure 3
Changes in modifiable risk factors. (A) Change in blood pressure. (B) Change in lipids. (C) Attainment of blood pressure and LDL-C goals. (D) Change in smoking status. **p < 0.0001 vs. baseline. †At baseline, 28.9% and 29.8% of patients in the usual care and intervention groups respectively, were at LDL-C goal; < 1% of patients were at blood pressure goal at baseline. BP, blood pressure; LS, least square; CI, confidence interval; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol
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