The EUROACTION preventive cardiology program

1
The EUROACTION preventive cardiology program

• Purpose
• To investigate whether a Europe-wide preventive
  cardiology program would improve standards of
  preventive care in routine clinical practice for
  patients with coronary heart disease and for
  asymptomatic individuals at high risk of
  cardiovascular disease
• Reference
• Wood DA, Kotseva K, Connolly S, et al. on behalf
  of EUROACTION Study Group. Nurse-coordinated
  multidisciplinary, family-based cardiovascular
  disease prevention programme (EUROACTION) for
  patients with coronary heart disease and
  asymptomatic individuals at high risk of
  cardiovascular disease a paired,
  cluster-randomized controlled trial. Lancet
  200837119992012.

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The EUROACTION preventive cardiology program -
TRIAL DESIGN -

• Design
• Multicenter, matched, cluster-randomized,
  controlled trial in six pairs of hospitals and
  six pairs of general practices in eight European
  countries.
• Patients
• 3088 patients with coronary heart disease
  (recruited from hospitals) and 2317 asymptomatic
  individuals at high risk of cardiovascular
  disease (recruited from general practices).
• Follow-up and primary endpoints
• Primary endpoints were family-based lifestyle
  change (smoking, diet, anthropmetry, physical
  activity), management of blood pressure, lipids
  and blood glucose to target concentrations, and
  prescription of cardioprotective drugs. All
  endpoints were measured at 1 year.
• Treatment
• The EUROACTION intervention program (a
  nurse-coordinated multidisciplinary, family-based
  cardiovascular disease prevention program) or
  usual care.

3
The EUROACTION preventive cardiology program -
TRIAL DESIGN continued -
Participant demographics

Coronary patients
High-risk patients
Intervention
Usual care
Usual care
Intervention
1694
1128
1718
1257
Identified
1589
1499
n/a
Eligible
1189
1061
332
Initial assessment
306
1118
1-year assessment
946
994
1019
1005
Age mean (yrs)
63.0
62.8
62.5
62.0
Age group (yrs)
22
22
22
15
lt55
35
34
44
48
5564
42
44
37
34
64
Men
70
70
57
50
Diagnosis
AMI/Heart score 5
47
54
42
51
16
Unstable angina/BP-lipids
21
27
23
Stable angina/diabetes
36
25
31
26
Abbreviations AMI, acute myocardial infarction
BP-lipids, patients on antihypertensiveor
lipid-lowering treatments random sub-sample
only.
Wood et al. Lancet 200837119992012.
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The EUROACTION preventive cardiology program -
RESULTS -

• Compared with usual care, the EUROACTION program
  was associated with the following
• A trend towards a greater likelihood of smoking
  cessation (in coronary patients)
• Reduced consumption of saturated fat (in coronary
  patients), and increased consumption of fruit and
  vegetables, fish (in high-risk patients) and oily
  fish (in coronary patients)
• A greater proportion achieving physical activity
  targets (all patients)
• A greater proportion achieving blood-pressure
  targets (all patients)
• A greater proportion achieving low-density
  lipoprotein (LDL)-cholesterol targets (in
  coronary patients)
• More frequent prescription of statins (all
  patients) and angiotensin-converting enzyme
  inhibitors (high-risk patients)

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The EUROACTION preventive cardiology program -
RESULTS continued -
Percentage of participants achieving the primary
endpoints at initial assessment

Coronary patients
High-risk patients
UC (n306)
Int (n1061)
UC (n252)
Int (n1118)
Not smoking
85
69
88
69
43
36


Saturated fat (lt10 of total energy)
5
3
3
5
Oily fish (3 times per week)
66
56
59
62
Fish (20 g per day)
Fruit and vegetables (400 g per day)
45
28
50
35
Physical activity (30 min, 4 times per week)
26
24
29
32
Body mass index (lt25 kg/m2)
22
23
19
18
Ideal waist circumference (men lt94 cm women lt80
cm)
26
28
20
17
Blood pressure (lt140/90 mm Hg orlt130/85 mm Hg in
individuals with diabetes)
66
38
64
37
Total cholesterol (lt5 mmol/L)
74
69
23
31
LDL-cholesterol (lt3 mmol/L)
70
37
75
28
HbA1c (lt7 in individuals with diabetes)
72
47
42
72
Antiplatelet drugs
94
95
8
9
ß blockers
78
85
13
12
Angiotensin-converting enzyme inhibitors
47
16
55
19
Statins
79
79
15
18
Wood et al. Lancet 200837119992012.
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The EUROACTION preventive cardiology program -
RESULTS continued -
Percentage of participants achieving the primary
endpoints at 1 year

Coronary patients
High-risk patients
UC (n306)
Int (n1061)
UC (n252)
Int (n1118)
Not smoking
47
72
58
73
55
40


Saturated fat (lt10 of total energy)
8
6
17
11
Oily fish (3 times per week)
66
79
67
83
Fish (20 g per day)
Fruit and vegetables (400 g per day)
72
35
78
39
Physical activity (30 min, 4 times per week)
54
20
50
22
Body mass index (lt25 kg/m2)
27
21
23
22
Ideal waist circumference (men lt94 cm women lt80
cm)
31
21
23
15
Blood pressure (lt140/90 mm Hg orlt130/85 mm Hg in
individuals with diabetes)
55
41
65
58
Total cholesterol (lt5 mmol/L)
77
71
36
31
LDL-cholesterol (lt3 mmol/L)
74
35
81
45
HbA1c (lt7 in individuals with diabetes)
65
56
53
80
Antiplatelet drugs
93
92
13
10
ß blockers
76
80
17
16
Angiotensin-converting enzyme inhibitors
56
20
52
29
Statins
86
80
38
23
Data in red indicate a statistically significant
difference between the intervention and treatment
groups (plt0.05)
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The EUROACTION preventive cardiology program -
RESULTS continued -
Proportion of non-smoking patients at the initial
and 1-year assessmentsamong those reported as
smoking in the month before the index event
100
Wood et al. Lancet 200837119992012.
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The EUROACTION preventive cardiology program -
RESULTS continued -
Changes in proportions of high-risk patients
achieving the Europeantarget for concentrations
of lipids between initial and 1-year assessments
Wood et al. Lancet 200837119992012.
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The EUROACTION preventive cardiology program -
SUMMARY -

• EUROACTION demonstrates that standards of
  preventive care in general hospitals and general
  practices across Europe can be improved.
• This nurse-led, multidisciplinary, family-based
  program achieved healthier lifestyle changes and
  improvements in other risk factors for patients
  with coronary heart disease and for those at high
  risk of cardiovascular disease than for those in
  usual care.
• EUROACTION is a model of preventive cardiology.
  It has been successfully implemented and
  assessed, and can be used in routine clinical
  practice.
• To fulfil the potential for cardiovascular
  disease prevention, we need local preventive
  cardiology programs that are adapted to the
  medical, cultural and economic setting of a
  country, and which are accessible through all
  hospitals and general practices.