Hotline sessions of the 28th European Congress of Cardiology/World Congress of Cardiology 2006

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Abstract
The EuroAction study was presented by David Wood from London, UK. This cluster randomized study assessed a strategy to improve adherence to evidence-based medicine in primary and secondary prevention of cardiovascular disease. A nurse-led multi-disciplinary prevention programme (intervention arm) was compared to usual care with respect to achieving preventive treatment goals as formulated in the European preventive cardiology guidelines. The patients' partners or direct relatives also participated in the study. The primary endpoints were the proportion of patients achieving the preventive treatment goals. Patients could enter from two sources. First, patients with chronic stable angina or acute coronary syndrome were recruited from hospitals. Second, patients at high risk for vascular events were recruited from general practices. Patients from the hospital followed a 16-week programme and those from general practices followed a 1-year programme. At the end of the respective programmes, the effect of the intervention was assessed. The data of 8657 patients and partners, recruited from 24 centres spread over eight European countries, were presented. Smoking cessation by patients from the hospital tended to be more frequent in the intervention arm than in the usual care arm (58 vs. 47%, P=0.06); a little over 70% of the patients from general practice stopped smoking in both arms. The dietary goals, especially regarding the consumption of fruits and vegetables, were achieved more often in the intervention group. With respect to physical activity, targets were reached twice as frequent in the intervention group: ∼50% compared with 20%. Among the partners, physical activity was positively influenced as well. The intervention led to more patients achieving an ideal waist circumference: ∼30% compared with 20% in the usual care arm, mainly accounted for by more male subjects achieving this treatment goal. Risk factors also were better managed in the nurse-led programme: blood pressure targets were more often reached, glycaemic control was better, and lipid levels more often improved. Finally, the use of cardio-protective drugs was improved. The hospital group with coronary artery disease (CAD) patients more frequently received antiplatelet therapy, statins, and beta-blockers. The high-risk patients from general practices more frequently received diuretics, angiotensin-converting enzyme-inhibitors (ACE-inhibitors), and statins. In conclusion, a nurse-led multi-disciplinary approach to cardiovascular risk intervention is associated with a higher proportion of patients reaching treatment targets, and a more optimized pharmacological treatment of coronary patients, and high-risk primary prevention patients.

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