Encouraging results of the RESPONSE study
The Dutch multicentre RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) conducted by prof. Ron Peters, published promising results in Heart (2013 Jun 28). The randomised controlled trial evaluated the effect of a hospital-based nurse-coordinated secondary cardiovascular prevention programme on top of routine clinical care in 754 patients that recently had suffered from an acute coronary syndrome. Primary outcome was the SCORE 10-year cardiovascular mortality risk at 12 months.
People randomised to the nurse-programme visited a cardiovascular nurse 4 times during the first 6 months after inclusion. The programme focussed on healthy lifestyle, risk factor profile and medication adherence. The nurses followed a motivational interviewing course and gave individual counselling for achieving smoking cessation, healthy weight, diet and adequate physical exercise levels. Medication for hypertension and hypercholesterolemia was adjusted in collaboration with the responsible specialist. Special attention was paid at medication adherence. People randomised to the control-arm were provided care as usual.
Cardiovascular mortality risk reduction
Mean age of participants was 58 years and 80% were men. 73% did not have a history of previous cardiovascular disease before the qualifying admission. At 12 months the mean SCORE risk estimate was 4.4% (SD4.5) in the intervention group and 5.4% (SD6.2) in the control group, showing a small but significant risk reduction for the intervention group. The intervention group showed significant improvement of blood pressure control, LDL cholesterol, physical activity levels and diet. In both groups approximately half of the people smoking achieved smoking cessation at 12 months (data collected by self-report). Interestingly, significantly less cardiac re-hospitalisations occurred in the intervention group compared to the control group (39% vs 61%).
The study shows that a nurse-coordinated programme for secondary prevention focussing on healthy lifestyle and adherence to medication can effectively reduce 10 – year cardiovascular mortality risk. The data suggest that the programme may also reduce cardiac re-hospitalisations.
RESPONSE includes a different population than HATICE and the intervention is not internet based. Still results are encouraging since they show nurses are successful in cardiovascular risk management and underline the importance of addressing lifestyle in prevention initiatives.