None listed
Conditions
Brief summary
Sudden heart events are a major health problem and account for about 22% of Australian deaths annually. However, more than 80% of survivors don’t enrol in programs aimed at lowering another attack. We have previously shown that first time survivors who do not use existing cardiac rehabilitation programs have higher coronary risk factors yet were prepared to participate in a brief, guided-choice modular program which resulted in showed significantly improved risk factor level and would lower their chance of a future heart event. The benefit was apparent at 3 months and maintained at 1 year. Given the importance of these findings we aim to determine whether they can be replicated across a range of hospitals and to determine whether periodic reinforcement improves outcomes further and for 3 years.
Interventions
Intervention is participation in a 12 month CHOICE program that includes a one-hour initial consultation and a few follow-up phone calls over three months. The program has four stages and was designed as an individualized, structured, case-management approach and was overseen by treating physicians. Stage one involves the development of modules and tailoring of leaflets by thorough investigation of local programs for each risk factor. Stage two involves face-to-face risk factor assessment and
Intervention is participation in a 12 month CHOICE program that includes a one-hour initial consultation and a few follow-up phone calls over three months. The program has four stages and was designed as an individualized, structured, case-management approach and was overseen by treating physicians. Stage one involves the development of modules and tailoring of leaflets by thorough investigation of local programs for each risk factor. Stage two involves face-to-face risk factor assessment and measurement, generating a list of each patient’s relevant risk factors. In stage three, patients make guided choices about which risk factors they will lower, participate in goal-setting informed by current national targets for the chosen risk factors, and select which management option(s) they will use to lower risk. All CHOICE patients participate in a core module for lowering cholesterol (including healthy eating advice and pharmacotherapy) given its major impact on reducing recurrent events. Up to two choice modules including blood pressure-lowering, smoking cessation, increased physical activity and nutrition are also offered depending on individual patient need and preference. After choosing relevant risk factor modules, patient selected their preferred management option(s) and make a self-commitment to a written action plan and are formally referred where appropriate (eg, smoking cessation clinic appointment made). Patients are also provided with a tailored resource package and a summary of the chosen risk factors, goals and interventions is mailed to the family physician, cardiologist and the patient. Stage four of the CHOICE program is telephone follow-up.
Sponsors
ANZAC Research Institute, Concord Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Diagnosis of ACS in the four weeks prior to recruitment; refusal of the initial invitation to participate in standard CR; failure to attend initial CR assessment.
Exclusion criteria
Clinical diagnosis of uncompensated, severe cardiac failure (Class IV); uncontrolled arrhythmia or angina; severe or symptomatic aortic stenosis; persistent hypotension (SBP < 90mmHg); clinical diagnosis of a severe coexisting medical condition that would prevent participation (eg, dementia, a terminal illness, severe rheumatoid arthritis); or insufficient English to provide written informed consent.
Outcome results
None listed