EUROACTION: Cardiologists should champion prevention as well as cure

EUROACTION: Cardiologists should champion prevention as well as cure:

"Sep 3, 2006
Lisa Nainggolan
Barcelona, Spain - Results from the largest-ever European-wide preventive cardiology project, EUROACTION, show that a nurse-led multidisciplinary team approach, together with the support and involvement of a patient's family, can generate significant lifestyle improvements and risk-factor reductions in coronary patients and those at risk of developing cardiovascular disease.
The message for cardiologists, says lead investigator Dr David Wood (Imperial College, London, UK), "is that you need to match your PCIs with a preventive program." Wood presented the results of EUROACTION today at the hotline session during the World Congress of Cardiology 2006.
"What we now know is that there has been a collective failure of medical practice to address lifestyle and risk-factor targets. We have clearly demonstrated that this nurse-led program works in a wide range of European countries, in ordinary general hospitals and GP surgeries," he told heartwire. "On the basis of these impressive results, we are going to talk to the national cardiology societies to discuss how we can implement this," he added.
Dr Thomas A Pearson (University of Rochester, NY), who was the discussant for the study, said EUROACTION "will become the benchmark to improve upon. It joins a list of landmark studies of implementation of what we already know from intervention studies."
Eight countries and almost 9000 patients
EUROACTION spanned eight countries—Denmark, France, Italy, the Netherlands, Poland, Spain, Sweden, and the UK—and 24 hospital and general practice centers, in a cluster randomized trial. It addressed the cardiovascular health of more than 8500 patients—half of whom already had coronary heart disease (recruited in hospitals) and half of whom were deemed high risk (from GP practices)—and compared outcomes with "usual-care" patients.
Unusually, partners were also included, something Pearson said was "particularly novel." The EUROACTION nurses performed complete lifestyle and risk-factor assessment of patients and partners and then supported them in making lifestyle changes. Advice was issued according to European preventive cardiology guidelines published in 2003 [1].
In hospitals, this involved regular one-to-one meetings as well as group workshops with members of a multidisciplinary team (including dieticians, physiotherapists, and cardiologists). For the high-risk patients, advice was given by nurses and GPs alone.
Significant improvements were observed after one year, not only in the EUROACTION patients but also in their partners, compared with patients treated by usual care and their partners, across a number of key lifestyle and risk factors.
Significantly more patients in both groups met physical-activity targets, reduced weight, reached blood-pressure goals, and improved use of cardioprotective therapies compared with usual-care patients.
For diet, significant improvements were seen in all three areas—increasing consumption of fruits and vegetables, eating more oily fish, and reducing saturated fat intake—in the coronary patients. For the high-risk patients, only fruit and vegetable intake was significantly improved compared with usual-care patients.
Hospital patients achieved significant reductions in waist circumference, but the GP patients did not, compared with usual care. For LDL-cholesterol levels, the opposite was true—the high-risk GP patients achieved significant reductions but the hospital coronary patients did not, compared with usual-care patients.
Smoking cessation was not significantly improved in either group compared with usual-care patients, but the hospital patients "came quite close with a p-value of 0.06," Wood told heartwire.
Even though significance was not achieved in some key areas, the trends were all in the right direction, he noted, adding that the study was underpowered.
Pearson observed that this "is a difficult kind of research to do. It's a different kettle of fish from efficacy studies."
The partners varied in their abilities to achieve targets but came out significantly better than the partners of the usual-care patients for fruit and vegetable consumption and physical activity.
Cost-effectiveness analysis planned
Wood also revealed that EUROACTION included a cost-effective analysis, with results expected in six months.
"This unique project has shown we can raise standards of preventive cardiology care for coronary and high-risk metabolic patients and their families in everyday care," he commented.
European Society of Cardiology president Dr Michal Tendera said: "It is now up to us to follow the EUROACTION example and work to establish similar prevention programs in every general hospital and GP practice so that patients across Europe can achieve the best possible care."
Source
De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2003; 24 (17): 1601-1610.
Related link
EuroAction Demonstration Project in Preventive Cardiology