A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile
A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile
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DOI：
10.1111/j.1742-1241.2008.01872.x
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发表时间：
2008-10-01
影响因子：
2.6
通讯作者：
Girerd, X.
中科院分区：
文献类型：
--
作者：
Benner, J. S.;Erhardt, L.;Girerd, X.
目的：我们评估了一种新的评估/交流预测冠心病（CHD）风险的计划是否可以降低患者的预测冠心病风险。研究方法：风险评估和沟通健康结局和利用试验是一项前瞻性、对照、随机分组试验，在9个欧洲国家的中度心血管风险患者中进行。在基线评估后，干预组的医生计算患者的预测CHD风险，并根据风险评估/沟通计划指导患者。家庭护理医生没有计算患者的风险，只提供常规护理。主要终点是干预治疗与常规治疗6个月时的Frachial 10年CHD风险。结果：在100个研究中心的1103例患者中，对524例接受干预的患者和461例接受常规护理的患者进行了疗效分析。6个月后，干预组的平均预测风险为12.5%，常规治疗组为13.7%[比值比= 0.896; p = 0.001，根据基线风险（17.2%干预; 16.9%常规治疗）和其他协变量进行校正]。干预组达到血压和低密度脂蛋白胆固醇目标的患者比例（25.4%）显著高于常规治疗组（14.1%; p < 0.001），干预组中29.3%的吸烟者戒烟，而接受常规治疗的吸烟者戒烟率为21.4%（p = 0.04）。结论：与常规护理相比，医生实施的CHD风险评估/交流计划改善了患者的可改变风险因素概况，并降低了预测的CHD风险。通过将这一策略与更强化的治疗相结合，以降低剩余的可改变风险，我们相信在临床实践中可以实现心血管疾病预防的实质性改善。
Aims: We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care. Methods: The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster-randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients' risk and provided usual care only. The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care. Results: Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04). Conclusions: A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice.