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Patient-centered modular secondary prevention following acute coronary syndrome: a randomized controlled trial
Redfern J, Briffa T, Ellis E, Freedman SB
Journal of Cardiopulmonary Rehabilitation and Prevention 2008 Mar-Apr;28(2):107-115
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: Cardiac rehabilitation (CR) is beneficial for those who attend, but alternative models for nonattenders need investigation. We tested the effectiveness of modular prevention on risk factors in survivors of acute coronary syndrome (ACS) not accessing CR. METHODS: We randomly allocated ACS survivors not accessing CR to a control group (n = 72) receiving conventional care or modular group (n = 72) who participated in risk factor modules on the basis of patient-centered care and collaborative goal setting to systematically lower risk factors. We also recruited a consecutive reference group of ACS survivors participating in CR (n = 64). Blinded measurements of risk factors and global risk were completed at baseline and 3 months. RESULTS: Although well matched for risk factor level and prevalence at baseline, by 3 months, the modular group had significantly reduced risk factor level in comparison with controls for most risk factors including total cholesterol (158 +/- 3.9 versus 186 +/- 3.9 mg/dL, p < 0.001), systolic blood pressure (133.5 +/- 2.0 versus 144.4 +/- 2.4 mmHg, p < 0.01), body mass index (28.9 +/- 0.7 versus 31.0 +/- 0.7 kg/m, p = 0.02), and physical activity (1,187 +/- 164 versus 636 +/- 115 metabolic equivalents (METS)/kg/min, p < 0.01). Also at 3 months, fewer patients in the modular group smoked than in the control group (6% versus 23%, p < 0.01) and were in the moderate to high-risk category of the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) score (40% versus 59%, p = 0.02). Although the modular group had higher risk factors at baseline, they achieved similar mean levels as the CR group at 3 months. CONCLUSIONS: Patient-centered modular prevention significantly improves coronary risk profile in comparison with conventional care and provides an effective alternative for the large numbers of ACS survivors not accessing CR.
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