The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial

Abstract

Objective: To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme “Healthy Heart”, addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. Design: A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost–utility analysis was performed. During the intervention period, “Healthy Heart” was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. Results: In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3–6 months and 12–24 months. Intervention versus control (95% CI) 3–6 months: weight: β −0.5 (−1.08–0.05); SBP β 0.15 (−2.70–2.99); LDL-cholesterol β 0.07 (−0.22–0.35); HDL-cholesterol β −0.03 (−0.10–0.05); physical activity β 38 (−97–171); diet β 0.95 (−0.93–2.83); alcohol OR 0.81 (0.44–1.49); quit smoking OR 2.54 (0.45–14.24). Results were similar for 12–24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: −0.10 (−0.20; 0.002); costs: EUR 106 (−80; 293)). Conclusions: For both the shorter (3–6 months) and longer term (12–24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.

Implementation of a group-based lifestyle intervention programme (Healthy Heart) in general practices in The Netherlands: a mixed-methods study

“…Remarkably, the most prevalent mentioned barrier was that patients were not informed about the existence of the programme. This also puts the results of the effectiveness and cost-effectiveness study in a different light; 23 this study investigated whether implementing the HH programme was effective and cost-effective on a population level by giving lifestyle change a boost during the intervention period. Implementation of the programme in general practices was found not to be effective or cost-effective on a population level.…”

“…Effectiveness, maintenance and cost-effectiveness are discussed in a separate paper. [23] Qualitative data: Experiences of health care providers (HCPs) and eligible patients Both GP practices and eligible patients were selected by purposive sampling. Both patients that participated (further referred to as participants) and patients that did not participate (further referred to as non-participants) in the HH-programme were recruited from the HH-study.…”

“…This also puts the results of the (cost-)effectiveness study in a different light. [23] This study investigated whether implementing the HH-programme was (cost-)effective on a population level by giving lifestyle change a boost during the intervention period. Implementing the programme in general practices was not (cost-)effective on population level.…”

Dutch GPs’ perspectives on addressing obesity: a qualitative study

“…Studies showed that awareness and knowledge among GPs regarding content and effectiveness of healthcare innovations, such as CLIs, are crucial for developing a positive attitude towards these innovations. 37,[42][43][44] Therefore, providing education and involvement of the GP could contribute to increased referrals to CLIs. A positive development is that healthcare insurances have started to reimburse CLIs in January 2019 in the Netherlands.…”