Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists.

Ron JG Peters, MD

On behalf of the RESPONSE Investigators

Academic Medical Center - University of AmsterdamThe Netherlands

Support

• Unrestricted grant from AstraZeneca, the Netherlands.

• No conflicts of interest

Background

• Secondary prevention may effectively prevent recurrent cardiovascular events.

• Guidelines have been issued by ESC, AHA/ACC • A gap exists between these guidelines and

clinical practice• New, practical initiatives are needed to reduce

this gap

Study design

Study goal: • To quantify the impact of a nurse coordinated

prevention program on risk factor levels in patients with a recent coronary event

Study design

Multicenter (n=11)randomised clinical trialin The Netherlands

Patients:• 18-80 years (n=754)• Discharged after ACS

(unstable angina/AMI)

Study flowchart

Primary outcome

blinded

Primary outcome

• SCORE risk estimate at 12 months• 10-year cardiovascular mortality

– Gender & Age– Smoking status– Total cholesterol– Systolic blood pressure

Targets Nurse Intervention

Baseline characteristics

risk factors:proportion on target

Medication

5.4%

Primary outcomecalculated 10 year mortality (SCORE)

Primary outcomecalculated 10 year mortality (SCORE)

p=0.029

5.4%

4.5%

RR reduction 16.9%

Complete attendance93.3%

Framingham risk estimation(Secondary Outcome)

risk factors:proportion on target

Diabetes Mellitus

Identified as diabetic and referred, but no diagnosis:

Classification of achievementof risk factor targets

Classification of achievementof risk factor targets

Conclusions (1)

• The RESPONSE nurse coordinated prevention program resulted in lowering of cardiovascular risk in patients with a recent acute coronary event.

• This was achieved on top of high level usual care.

• Risk reduction was sustained at follow-up.

Conclusions (2)• The program was effective in achieving targets

for systolic blood pressure, LDL cholesterol, and healthy lifestyles.

• The program did not impact on weight and smoking status.

• Insulin resistance was highly prevalent but received insufficient attention.

Conclusions (3)

• The program, with up to 4 outpatient clinic visits, was well attended and feasible.

• The nurse coordinated prevention program can readily be implemented into daily practice.

Acknowledgements: our nurses

Janine Doornenbal

Annemarie von Drimmelen

Harold Helmes

Irma Kremer

Franciska Kuijper

Rob Lardinois

Naomi Moerman

Annie Obbema

Aafje Reijenga

Leon Schotman

Lennie Setten van der Meer

Ira van Sleeuwen

Ann Klein Twennaar

Eelkje Wolf

Doetie van der Woude

RESPONSE study group