Date Published: 14 September 2006
Largest demo in preventive cardiology improves heart health across Europe
Results from EUROACTION show that a nurse-led multi-disciplinary team approach, coupled with the support and involvement of a patient's partner and family, can yield significant lifestyle improvements and risk factor reductions in coronary patients and patients at risk of developing cardiovascular disease.
The largest ever European-wide preventive cardiology project, EUROACTION spanned eight countries and 24 hospital and general practice centres, in a cluster randomized controlled trial. The project addressed the cardiovascular health of over 10,000 coronary and high risk patients and their partners, according to the European preventive cardiology guidelines. The inclusion of partners and family members underpinned EUROACTION's emphasis on family support and a shared commitment to heart-healthy living.
Professor David Wood, Professor of Cardiovascular Medicine at Imperial College London and Chairperson of EUROACTION commented:
" With current treatment failing too many cardiovascular patients across Europe, EUROACTION has stepped up to the professional challenge of translating scientific evidence into effective care. Prevention guidelines are very difficult to implement, but the EUROACTION approach sets a new standard for preventive care across Europe which all hospitals and general practices can achieve."
Significant improvements were observed not only in EUROACTION patients but also in their partners, compared to usual care in other hospitals and general practices, across the key lifestyle and risk factors: diet (fruit and vegetable, saturated fat and oily fish intake), physical activity, central obesity, blood pressure, cholesterol and glucose. The administration of cardio-protective medication - anti-platelet therapy, beta-blockers, ACE inhibitors and statins - was also improved.
Through the EUROACTION programme, three-quarters of patients (72% coronary and 78% high risk) and their partners (72% coronary and 77% high risk partners) achieved the recommended fruit and vegetable consumption (of = 400g/day, equivalent to five standard portions), compared to just over a third of usual care patients (35% coronary and 39% high risk) and coronary partners (37%) and just over half the high risk patients' partners (54%). EUROACTION coronary patients also reduced their consumption of saturated fat (to <10% total energy achieved by 55% coronary EUROACTION patients versus 40% usual care) and twice as many met the recommended weekly intake of oily fish (= 3x/week achieved by 17% versus 8% in usual care), with similar trends seen in high risk patients and both partner groups.
Of the coronary patients and partners who were smokers at the time of the patient's cardiovascular event, over half the patients (58%) and nearly a quarter (23%) of their partners, stopped smoking and remained non-smokers at one year, an improvement on those in usual care (47% coronary patients and 18% partners).
Physical activity targets (of 30-45 minutes of exercise, four to five times per week, at 60-75% of average maximum heart rate), were achieved by twice as many EUROACTION patients as compared to usual care (54% coronary and 50% high risk EUROACTION patients, versus 20% and 22% respectively for usual care). EUROACTION partners again reflected this trend, with almost half as many achieving the exercise target as their peers in usual care (41% coronary and 44% high risk partners, versus 27% and 25% respectively in usual care).
In turn, central obesity (a waist circumference of = 94 cms in men or = 80 cms in women) was reduced across EUROACTION patients as compared to usual care (35% coronary and 27% high risk EUROACTION patients achieved an ideal waist circumference, compared to 22% and 21% respectively in usual care).
Blood pressure targets, according to European levels (<140/90 mmHg, or <130/85 mmHg for patients with diabetes) were consistently better achieved by patients on the EUROACTION programme, both for patients with and patients without diabetes. Almost three quarters (72%) of non-diabetic coronary and over two thirds (66%) of non-diabetic high risk patients met the targets, consistently higher than the usual care results in each case (60% for coronary and 48% for high risk). Diabetic patients reached their blood pressure target more successfully in the EUROACTION arm, with twice as many (38%) coronary diabetic patients reaching target than in usual care (17%), and the same for high risk EUROACTION diabetic patients; 38% at target compared to 19% in usual care
Cholesterol targets (Total cholesterol of <5 mmol/l) were achieved by the majority of both EUROACTION coronary (78%) and usual care coronary (71%) patients, and high risk EUROACTION patients demonstrated a significant increase in target achievement (from 23% to 36%) across the year, whilst the proportion of usual care high risk patients on target remained unchanged during the programme.
The recommended glycated haemoglobin target in diabetes was achieved by more EUROACTION patients (HbA1c of < 7%) as compared to usual care (coronary patients 61% versus 50% for usual care; high-risk patients 80% versus 65% for usual care) reflecting better long term diabetic control.
Cardio-protective therapies, such as anti-platelets, beta-blockers, diuretics, ACE inhibitors and statins, were all found to be used more frequently in EUROACTION than in usual care patients, both in hospital and general practice, although to a lesser extent in the latter. These improvements in prescribing were achieved with lower cost generically available drugs from local formularies.
Professor David Wood, Chairperson of EUROACTION commented,
" The principles of nurse-led multi-disciplinary teams, family-based lifestyle intervention as well as total cardiovascular risk management are all central features of EUROACTION which has demonstrated the potential to significantly improve the quality of patient care. Moreover, having run our prevention programme in busy hospitals and general practice settings, these results are directly applicable to everyday clinical practice."
Professor Michal Tendera, President of the ESC, said,
" The European Society of Cardiology produces guidelines which set standards for best practice and measure the uptake of these through European-wide surveys. Now, for the first time, our society has demonstrated, through the EUROACTION project, that we can achieve these targets in a large majority of patients and to great effect. It is now up to us to follow the EUROACTION example and work to establish similar prevention programmes in every general hospital and general practice so that patients across Europe can receive the best possible care".
Source: Imperial College, London (England, UK).