Action to improve secondary prevention in coronary heart disease patients: one-year follow-up of a shared care programme*1

Abstract Background Implantable cardioverter- defibrillator (ICD) therapy is established for prevention of sudden cardiac death (SCD) in different entities. However, data from large patient cohorts on patients with electrical heart disease of hypertrophic cardiomyopathy (HCM) is rare. Therefore, we investigated these patients by analysing registry data from a multi-center “real-life” registry. Methods The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5450 patients receiving device implantations in 50 German centres. The present analysis of DEVICE focussed on patients with electrical heart disease or HCM who received an ICD for primary or secondary prevention. Results 174 patients with HCM and 112 patients with electrical heart disease were compared with 5164 other ICD patients. Median follow-up was 17.0 months. Patients in the control group were significantly older. Of note, overall mortality after one year was 1.8% in HCM patients, 6.6% in patients with electrical heart disease and 7.3% in the control group. Patients in the control group presented significantly more severe comorbidities. In contrast to HCM patients and the control group where primary prevention was the major indication for ICD implantation 77.5% of patients with electrical heart disease received an ICD for secondary prevention. The number of surgical revisions was higher in patients with electrical heart disease. Conclusion Data from the present registry display a surprisingly high mortality in patients with electrical heart disease equivalent to the control group. A high proportion of patients who received an ICD for secondary prevention may be regarded as a major determinant for these results while severe comorbidities such as diabetes, hypertension and renal failure are major determinants for mortality in the control cohort.

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Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service

Australian Journal of Primary Health ◽

10.1071/py12117 ◽

2014 ◽

Vol 20 (3) ◽

pp. 266 ◽

Cited By ~ 6

Author(s):

Dhruv Govil ◽

Ivan Lin ◽

Tony Dodd ◽

Rhonda Cox ◽

Penny Moss ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Chronic Disease ◽

Secondary Prevention ◽

Best Practice ◽

Medical Service ◽

Aboriginal People ◽

Lifestyle Modification ◽

Culturally Appropriate

Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n = 6) and staff (n = 6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P < 0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P < 0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.

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Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review and meta-analysis

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119826510 ◽

2019 ◽

Vol 18 (4) ◽

pp. 260-271 ◽

Cited By ~ 34

Author(s):

Kai Jin ◽

Sahar Khonsari ◽

Robyn Gallagher ◽

Patrick Gallagher ◽

Alexander M Clark ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Secondary Prevention ◽

Cardiac Rehabilitation ◽

Usual Care ◽

Weighted Mean Difference ◽

Grey Literature ◽

Cardiac Events ◽

All Cause Mortality

Background: Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with cardiac rehabilitation and/or usual care for patients with CHD. Methods: Relevant randomized controlled trials evaluating telehealth interventions in CHD patients with at least three months’ follow-up compared with cardiac rehabilitation and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalization/cardiac events and modifiable risk factors. (PROSPERO registration number 77507.) Results: In total, 32 papers reporting 30 unique trials were identified. Telehealth was not significant associated with a lower all-cause mortality than cardiac rehabilitation and/or usual care (risk ratio (RR)=0.60, 95% confidence interval (CI)=0.86 to 1.24, p=0.42). Telehealth was significantly associated with lower rehospitalization or cardiac events (RR=0.56, 95% CI=0.39 to 0.81, p<0.0001) compared with non-intervention groups. There was a significantly lower weighted mean difference (WMD) at medium to long-term follow-up than comparison groups for total cholesterol (WMD= −0.26 mmol/l, 95% CI= −0.4 to −0.11, p <0.001), low-density lipoprotein (WMD= −0.28, 95% CI = −0.50 to −0.05, p=0.02) and smoking status (RR=0.77, 95% CI =0.59 to 0.99, p=0.04]. Conclusions: Telehealth interventions with a range of delivery modes could be offered to patients who cannot attend cardiac rehabilitation, or as an adjunct to cardiac rehabilitation for effective secondary prevention.

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