Weight management and determinants of weight change in patients with coronary artery disease

ObjectiveTo study the effects of a comprehensive secondary prevention programme on weight loss and to identify determinants of weight change in patients with coronary artery disease (CAD).MethodsWe performed a secondary analysis focusing on the subgroup of overweight CAD patients (BMI ≥27 kg/m2) in the Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists-2 (RESPONSE-2) multicentre randomised trial. We evaluated weight change from baseline to 12-month follow-up; multivariable logistic regression with backward elimination was used to identify determinants of weight change.ResultsIntervention patients (n=280) lost significantly more weight than control patients (n=257) (−2.4±7.1 kg vs −0.2±4.6 kg; p<0.001). Individual weight change varied widely, with weight gain (≥1.0 kg) occurring in 36% of interventions versus 41% controls (p=0.21). In the intervention group, weight loss of ≥5% was associated with higher age (OR 2.94), lower educational level (OR 1.91), non-smoking status (OR 2.92), motivation to start with weight loss directly after the baseline visit (OR 2.31) and weight loss programme participation (OR 3.33), whereas weight gain (≥1 kg) was associated with smoking cessation ≤6 months before or during hospitalisation (OR 3.21), non-Caucasian ethnicity (OR 2.77), smoking at baseline (OR 2.70), lower age (<65 years) (OR 1.47) and weight loss programme participation (OR 0.59).ConclusionThe comprehensive secondary prevention programme was, on average, effective in achieving weight loss. However, wide variation was observed. As weight gain was observed in over one in three participants in both groups, prevention of weight gain may be as important as attempts to lose weight.Trial registration numberNTR3937.

Cost-Effectiveness Analysis of Implementing a Secondary Prevention Programme in Those Patients Who Visited an Emergency Department for Drug-Related Problems

Background: To evaluate the cost-effectiveness of a secondary prevention programme in patients admitted to the Emergency department due drug-related problems (DRPs) Methods: A decision model compared costs and outcomes of patients admitted to the Emergency department with drug-related problems included in Anatomical Therapeutic Classification (ATC) groups A, B or C was designed, based on the results of a randomized clinical trial (NCT03607097). Model variables and costs, along with their distributions, were obtained from the trial results and the literature. The study was performed from the perspective of the National Health System including only direct costs. The Incremental Cost-Effectiveness ratio (ICER) was analysed regarding the ability of the programme to reduce emergency department revisits. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. Results: According to the results of the proposed model, the implementation of a secondary prevention programme for DRPs reduces the cost associated with Emergency Department revisits, with an annual net benefit of €87,639. Considering a mortality rate attributable to readmission for DRPs of 4.7%, the cost per life-years gained (LYG) with the implementation of this program was €2,205. In the short term, the reduction in the number of revisits due to the implementation of the programme was the variable that most affected the model, with the benefit threshold value corresponding to a relative reduction of 12.4% of the number of revisits in patients with DRPs to obtain benefits with the implementation of this type of programme. Conclusions: Implementing a secondary prevention programme is cost-effective on patients admitted to the emergency department with DRPs. Implementation costs will be exceeded by reducing revisits to the emergency department.

Dissertation about Cardiac Rehabilitation

BackgroundMyocardial infarction (MI) is a major cause of death and disability worldwide. Many MI survivors potentially experience poor health-related quality of life (HRQOL). Outpatient cardiac rehabilitation (CR) programmes are widely accepted as beneficial for reducing mortality and morbidity among MI survivors. However, their effect on HRQOL has not been clearly identified. This systematic review aims to investigate the effectiveness of such a programme on HRQOL for post MI patients.MethodsThe following databases were searched for relevant information: MIDLINE, CINAHAL, EMBASE, AMED, Web of Science, and PsycINFO. They were searched from 1970 to July, 2012, for studies that investigated the effectiveness of outpatient cardiac rehabilitation in improving HRQOL for patients with MI. Studies were excluded if they did not separate MI patients from other cardiac conditions; included other CR modalities; and reported on just a component of HRQOL. ResultsOut of the 848 citations identified, only 11 studies were agreed upon by the reviewers and considered relevant for inclusion in this systematic review. The designs of included studies were non-controlled, non-randomised observational study; controlled, non-randomised observational study; and randomised controlled trials. Instruments used to assess HRQOL included SIP, SF-36, WHOQOL-BREF; QOLMI, MacNew and QOL- Cardiac Version III. All eleven studies confirmed that the HRQOL score of MI patients who participated in outpatient CR improved significantly compared to those who did not participate. In terms of the CR design, it is seems that the length between MI and CR initiation, CR duration, and intensity and frequency do not always affect improvements in HRQOL among participants. However, component of CR may have variable impacts in improving HRQOL. ConclusionOutpatient CR, regardless of its design and components, improves HRQOL of MI patients immediately following the programme. This implies that CR is the best secondary prevention programme and that all post MI patients should be considered as candidates for participation in CR.

Development of an online secondary prevention programme for stroke survivors: Prevent 2nd Stroke

BackgroundStroke events often result in long-term negative health outcomes. People who experience a first stroke event are 30%–40% more likely to experience a second stroke event within 5 years. An online secondary prevention programme for stroke survivors may help stroke survivors improve their health risk behaviours and lower their risk of a second stroke.ObjectivesThis paper describes the development and early iteration testing of the usability and acceptability of an online secondary prevention programme for stroke survivors (Prevent 2nd Stroke, P2S). P2S aims to address six modifiable health risk behaviours of stroke: blood pressure, physical activity, nutrition, depression and anxiety, smoking, and alcohol consumption.MethodsP2S was developed as an eight-module online secondary prevention programme for stroke survivors. Modelled on the DoTTI (Design and development, Testing early iterations, Testing for effectiveness, Integration and implementation) framework for the development of online programmes, the following stages were followed during programme development: (1) content development and design; and (2) testing early iteration. The programme was pilot-tested with 15 stroke survivors who assessed P2S on usability and acceptability.ResultsIn stage 1, experts provided input for the content development of P2S. In stage 2, 15 stroke survivors were recruited for usability testing of P2S. They reported high ratings of usability and acceptability of P2S. P2S was generally regarded as ‘easy to use’ and ‘relevant to stroke survivors’. Participants also largely agreed that it was appropriate to offer lifestyle advice to stroke survivors through the internet.ConclusionsThe study found that an online secondary prevention programme was acceptable and easily usable by stroke survivors. The next step is to conduct a randomised controlled trial to assess the effectiveness of the programme regarding behaviour change and determine the cost-effectiveness of the intervention.

Overview of Cardiac Rehabilitation Evidence, Benefits and Utilisation

Historically, the main objective of cardiac rehabilitation (CR) as an exercise-based programme was to restore or improve patients’ regular physical activity after a cardiac event. Since then CR has evolved into a comprehensive secondary prevention programme, the objectives of CR, and indications and contraindications for its use have also developed in sophistication. Current CR programmes are designed to stabilise or even reverse the progression of heart disease by controlling all modifiable risk factors. They are also concerned with improving patients’ quality of life by restoring their wellbeing. All this should be achieved with the maximum safety levels to patients. The first part of this review details on how CR evolved from a simple exercise programme to a comprehensive secondary prevention programme in the past few decades. The second part sets an example of modern CR provision, pathway and guidelines in a top leading country in this field, the UK.