Interventions to maintain cardiac risk control after discharge from a cardiovascular risk reduction clinic: a randomized controlled trial

Abstract

Aims: To evaluate the efficacy of two maintenance strategies compared to usual care after discharge from a pharmacist-led cardiovascular risk reduction clinic (CRRC).

Methods: Open-label, randomized-controlled trial of 200 consecutive CRRC patients that met clinic discharge criteria (HbA1c ≤7% (53 mmol/mol); blood pressure ≤140/80 mmHg for those with diabetes and ≤140/90 mmHg for those without diabetes; and an LDL-cholesterol ≤2.59 mmol/l). Participants were randomized to either quarterly group medical visits or quarterly CRRC individual clinic visits, or a usual care control arm with the standard primary care alone first in a 1:1:1 ratio, followed by a 2:2:1 ratio after first 100 patients. Primary outcome measures were time to failure for guideline recommended goals of HbA1c and blood pressure over 12-months.

Results: Of the 200 participants randomized, 89% had diabetes and were similar in other cardiovascular risk factors. After 1-year, the HbA1c failure rate was 0.36 [95% CI, 0.28-0.47] per quarter for the group medical visit arm, 0.24 [95% CI, 0.18-0.33] per quarter for the quarterly CRRC individual arm and, 0.82 [95% CI, 0.69-0.96] per quarter for the usual care control arm, p<0.001. The rate of failure for blood pressure was 0.31 [95% CI, 0.23-0.41] per quarter for the group medical visit arm, 0.22 [95% CI, 0.16-0.30] per quarter for the CRRC individual arm and, 0.53 [95% CI, 0.40-0.71] per quarter the control arm, p<0.001.

Conclusion: After discharge from a CRRC program, both individual and group interventions are more effective in maintaining glycemia and blood pressure control for patients with diabetes than usual care after 1-year of follow-up.

Keywords: Blood pressure; Diabetes; Hemoglobin A1c; Randomized controlled trial.