Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care

Abstract

After 10 years, differences between groups were no longer significant. Total mortality survival curves for the intervention and control groups had not converged, but the coronary event survival curves had. Possibly, therefore, the earlier that secondary prevention is optimised, the less likely a subsequent coronary event is to prove fatal.

Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis

“…In addition, there was variation in the intervention components, the length of the original interventions (varied from 1-3 years), and the length of observational follow-up (four studies had follow-up data at 4.7-6 years, [15][16][17][18] two studies had 10-year follow-up data 19,20 ). Follow-up data were reported at two different times for the Scottish study: 4.7 years 16 and 10 years.…”

“…Follow-up data were reported at two different times for the Scottish study: 4.7 years 16 and 10 years. 19 Five different intervention components were combined in different ways across the included studies (Table 1): patient education and pre-planned appointments (four studies) and clinician education, nurse-led interventions, and risk-factor management (three studies). The sample sizes were adjusted where required in all three clusterrandomised trials, using the methods recommended in the Cochrane Handbook.…”

“…death, a finding that is strengthened by the measurable statistical heterogeneity detected between the studies (t² = 0.01; P = 0.33, I² = 12%). Meta-analysis of data from two studies 19,20 including 1346 participants at 10-year follow-up indicated no statistically significant difference between the two groups for all-cause mortality (RR 0.91, 95% CI = 0.75 to 1.09) ( Figure 5), with almost negligible statistical heterogeneity (t² = 0.01; P = 0.31, I² = 3%), or for cardiac-related mortality (RR 0.95, 95% CI = 0.79 to 1.16).…”

“…18 Delaney reported no significant difference in the total number of hospital admissions between groups after 10 years. 19 It was not possible to pool data on hospital admissions.…”

Nurse involment in primary care: it is the key to improve the outcomes in primary and secondary prevention?

“…Per ovviare a questi inconvenienti, Delaney et al [9] ad Aberden hanno utilizzato il personale infermieristico per la gestione a lungo termine della prevenzione secondaria (Nurse Clinic) e per migliorare l'aderenza al trattamento medico e al nuovo stile di vita.…”