The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review Cardiovascular Risk Factor Screening Satisfaction in the Heart of New Ulm Project The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study: intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour Effect of Adding Systematic Family History Enquiry to Cardiovascular Disease Risk Assessment in Primary Care Impact of cardiovascular counseling and screening in Hodgkin lymphoma survivors. Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review The impact of individualised cardiovascular disease (CVD) risk estimates and lifestyle advice on physical activity in individuals at high risk of CVD: a pilot 2 × 2 factorial understanding risk trial Changes in CVD risk factors in the activity counseling trial Effects of Cardiovascular Disease Risk Communication for Patients With Type 2 Diabetes on Risk Perception in a Randomized Controlled Trial Cardiovascular prevention in general practice: development and validation of an algorithm Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study Multifactor cardiovascular disease risk reduction in medically underserved, high-risk patients. Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedged cluster RCT A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol
Objectives : The SCORE model predicts the ten-year risk of cardiovascular mortality but it is still unknown whether applying the SCORE in clinical practice subsequently improves cardiovascular disease ( CVD ) outcomes . The objective of this study is to assess the effect of total cardiovascular risk estimation using the SCORE in preventing serious cardiovascular events in European adults without prior CVD . Methods and results : Data sources : eight bibliographical data bases ( 2003 – August 2015 ) , other internet sources and reference lists of articles were checked . This was supplemented by contact with the board members of the European Society of Cardiology ( ESC ) and the authors of the SCORE model . Study eligibility criteria : all prospect i ve studies in any language investigating the effect of using the SCORE on the clinical outcome ( CVD death , major events and adverse outcomes ) in an adult population were examined . Two review ers assessed the studies independently ( titles , abstract s , full texts ) . After removal of duplicates , 5,256 records were screened and 14 full text papers considered . No eligible studies were identified . An extensive literature search revealed no r and omized control trial or other prospect i ve study comparing significant clinical outcomes between groups that used the SCORE and those who did not . Conclusions : The effect of using the SCORE ( with or without subsequent intervention ) on CVD death , all-cause mortality , major CVD events like myocardial infa rct ion and stroke , as well as adverse outcomes , is still unknown . A cluster r and omised controlled trial is warranted to evaluate the use of the SCORE on important outcomes Objective Community-based cardiovascular disease ( CVD ) risk factor screening programs have been used successfully in rural health improvement initiatives . However , little is known about what consumers like or dislike about them , which is a barrier to the design of future process improvements . The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction . Design This study utilized a cross-sectional survey design . Setting Data was collected as part of the broader Heart of New Ulm Project , which is a community-based CVD prevention demonstration project based in rural Minnesota . Participants There were 126 r and omly invited individuals from the CVD risk factor screenings , with 118 individuals who agreed to participate and had complete data available for analyses . Methods A multivariate logistic regression analysis was used to examine the association between demographics , lifestyle , and biometric risk factors and screening satisfaction . Results Twenty percent of respondents indicated some level of dissatisfaction with the screening process . Satisfied participants were more likely to be female ( OR=4.15 ) , not have an optimal lifestyle ( OR=3.47 ) , and have an intention to improve their lifestyle habits ( OR=3.26 ) . Age , education , and CVD risk level were not significant predictors in the final model . Conclusion Satisfaction was high in this screening program , with healthy males being least satisfied with their experience . This has implication s for the design of future intervention efforts , as they may require specific programmatic features and more specialized , targeted marketing strategies to attract a broad spectrum of participants likely to benefit Background Large gaps exist in the implementation of guideline recommendations for cardiovascular disease ( CVD ) risk management .  Electronic decision support ( EDS ) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia . We have developed HealthTracker , a multifaceted EDS and quality improvement intervention to improve the management of CVD risk . Methods / design It is hypothesised that the use of HealthTracker over a 12-month period will result in : ( 1 ) an increased proportion of patients receiving guideline -indicated measurements of CVD risk factors and ( 2 ) an increased proportion of patients at high risk will receive guideline -indicated prescriptions for lowering their CVD risk . Sixty health services ( 40 general practice s and 20 Aboriginal Community Controlled Health Services ( ACCHSs ) will be r and omised in a 1:1 allocation to receive either the intervention package or continue with usual care , stratified by service type , size and participation in existing quality improvement initiatives . The intervention consists of point-of-care decision support ; a risk communication interface ; a clinical audit tool to assess performance on CVD-related indicators ; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance .  The control arm will continue with usual care without access to these intervention components . Quantitative data will be derived from cross-sectional sample s at baseline and end of study via automated data extraction . Detailed process and economic evaluations will also be conducted . Ethics and dissemination The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee ( HREC ) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC . Formal agreements with each of the participating sites have been signed . In addition to the usual scientific forums , results will be disseminated via newsletters , study websites , face-to-face feedback forums and workshops . Trial registration The trial is registered with the Australian Clinical Trials Registry ACTRN 12611000478910 Background Cardiovascular disease ( CVD ) remains the leading cause of death globally . Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions . An integral part of this approach is the use of CVD risk scores . Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies . We aim to evaluate short-term effects of providing different types of information about coronary heart disease ( CHD ) risk , alongside lifestyle advice , on health-related behaviours . Methods / Design In a parallel-group , open r and omised trial , we are allocating 932 male and female blood donors with no previous history of CVD aged 40–84 years in Engl and to either no intervention ( control group ) or to one of three active intervention groups : i ) lifestyle advice only ; ii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics ; and iii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics . The primary outcome is change in objective ly measured physical activity . Secondary outcomes include : objective ly measured dietary behaviours ; cardiovascular risk factors ; current medication and healthcare usage ; perceived risk ; cognitive evaluation of provision of CHD risk scores ; and psychological outcomes . The follow-up assessment takes place 12 weeks after r and omisation . The experiences , attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups . Discussion The INFORM study has been design ed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours . Trial registration Current Controlled Trials IS RCT N17721237 . Registered 12 January 2015 BACKGROUND Evidence of the value of systematic ally collecting family history in primary care is limited . OBJECTIVE To evaluate the feasibility of systematic ally collecting family history of coronary heart disease in primary care and the effect of incorporating these data into cardiovascular risk assessment . DESIGN Pragmatic , matched-pair , cluster r and omized , controlled trial . ( International St and ardized R and omized Controlled Trial Number Register : IS RCT N 17943542 ) . SETTING 24 family practice s in the United Kingdom . PARTICIPANTS 748 persons aged 30 to 65 years with no previously diagnosed cardiovascular risk , seen between July 2007 and March 2009 . INTERVENTION Participants in control practice s had the usual Framingham-based cardiovascular risk assessment with and without use of existing family history information in their medical records . Participants in intervention practice s also completed a question naire to systematic ally collect their family history . All participants were informed of their risk status . Participants with high cardiovascular risk were invited for a consultation . MEASUREMENTS The primary outcome was the proportion of participants with high cardiovascular risk ( 10-year risk ≥ 20 % ) . Other measures included question naire completion rate and anxiety score . RESULTS 98 % of participants completed the family history question naire . The mean increase in proportion of participants classified as having high cardiovascular risk was 4.8 percentage points in the intervention practice s , compared with 0.3 percentage point in control practice s when family history from patient records was incorporated . The 4.5-percentage point difference between groups ( 95 % CI , 1.7 to 7.2 percentage points ) remained significant after adjustment for participant and practice characteristics ( P = 0.007 ) . Anxiety scores were similar between groups . LIMITATIONS Relatively few participants were from ethnic minority or less-educated groups . The potential to explore behavioral change and clinical outcomes was limited . Many data were missing for anxiety scores . CONCLUSION Systematic ally collecting family history increases the proportion of persons identified as having high cardiovascular risk for further targeted prevention and seems to have little or no effect on anxiety . PRIMARY FUNDING SOURCE Genetics Health Services Research program of the United Kingdom Department of Health PURPOSE Cardiovascular disease ( CVD ) is the most common nonmalignant cause of death in Hodgkin lymphoma ( HL ) survivors , especially after mediastinal irradiation . The role of screening for CVD in HL survivors is unclear , but confrontation with risks of CVD may have a negative influence on health-related quality of life ( HRQL ) . As part of a phase 2 screening study using computed tomography angiography ( CTA ) among HL survivors , an HRQL analysis was done to evaluate the emotional and practical burden and perceived benefits of screening and the effect of CVD-specific counseling on patient satisfaction . METHODS AND MATERIAL S Patients who participated in the screening study also took part in the HRQL study . The impact of undergoing screening was evaluated with a 9-item question naire , and impact on HRQL with the European Organization for Research and Treatment of Cancer ( EORTC ) Quality of Life Core Question naire C30 , version 3.0 . The effect of counseling of CVD on perceived provision of information was evaluated with EORTC INFO-25 . All question naires were completed at baseline and after screening . RESULTS Baseline question naires were received from 48 participants , and 43 completed question naires after screening .  Mean age was 47 years , and mean time since diagnosis was 21 years . Of the total , 93 % of subjects were content with participating , and 80 % did not find the emphasis placed on late effects burdensome , although screening did have a small impact on social functioning and global quality of life . Perceived information on disease , medical tests , and treatment increased significantly after screening ( P<.01 ) . Differences were clinical ly relevant . There were no differences in perceived information between patients with and without screen-detected CVD . CONCLUSIONS Screening was evaluated favorably , whether CTA showed abnormalities or not . Extensive counseling result ed in substantially increased provision of information and improved information satisfaction . Screening by means of CTA and subsequent cardiac intervention was highly valued , and the benefits were felt to outweigh the emotional and practical burden Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Background There is currently much interest in encouraging individuals to increase physical activity in order to reduce CVD risk . This study has been design ed to determine if personalised CVD risk appreciation can increase physical activity in adults at high risk of CVD . Methods / Design In a 2 × 2 factorial design participants are allocated at r and om to a personalised 10-year CVD risk estimate or numerical CVD risk factor values ( systolic blood pressure , LDL cholesterol and fasting glucose ) and , simultaneously , to receive a brief lifestyle advice intervention targeting physical activity , diet and smoking cessation or not . We aim to recruit 200 participants from Oxfordshire primary care practice s. Eligibility criteria include adults age 40–70 years , estimated 10-year CVD risk ≥20 % , ability to read and write English , no known CVD and no physical disability or other condition reducing the ability to walk . Primary outcome is physical activity measured by ActiGraph accelerometer with biochemical , anthropometrical and psychological measures as additional outcomes . Primary analysis is between group physical activity differences at one month powered to detect a difference of 30,000 total counts per day of physical activity between the groups . Additional analyses will seek to further eluci date the relationship between the provision of risk information , and intention to change behaviour and to determine the impact of both interventions on clinical and anthropometrical measures including fasting and 2 hour plasma glucose , fructosamine , serum cotinine , plasma vitamin C , body fat percentage and blood pressure . Discussion This is a pilot trial seeking to demonstrate in a real world setting , proof of principal that provision of personalised risk information can contribute to behaviour changes aim ed at reducing CVD risk . This study will increase our underst and ing of the links between the provision of risk information and behaviour change and if successful , could be used in clinical practice with little or no modification Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease ( CVD ) risk factors . The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial ( ACT ) on CVD risk factors , to examine whether changes in CVD risk factors differed according to baseline risk factor status , and to examine whether changes in fitness were associated with changes in CVD risk factors . ACT was a 24-month multicenter r and omized controlled trial to increase physical activity .  Participants were 874 inactive men and women aged 35–74 years . Participants were r and omly assigned to one of three arms that varied by level of counseling , intensity , and re source requirements . Because there were no significant differences in change over time between arms on any of the CVD risk factors examined , all arms were combined , and the effects of time , independent of arm , were examined separately for men and women . Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status . Significant improvements in total cholesterol , high-density lipoprotein cholesterol ( HDL-C ) and low-density lipoprotein cholesterol , the ratio of total cholesterol to HDL-C , and triglycerides were seen in both men and women who had high ( or low for HDL-C ) baseline levels of risk factors , whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels . There were no improvements in any risk factors among participants with normal baseline levels . Changes in fitness were associated with changes in a number of CVD risk factors . However , most relationships disappeared after controlling for changes in body weight . Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%–26 % in men and 11%–16 % in women . Interventions that can be implemented in health care setting s nationwide and result in meaningful population -wide changes in CVD risk factors are needed . The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors OBJECTIVE Patients with type 2 diabetes mellitus ( T2DM ) underestimate their risk of developing severe complications , and they do not always underst and the risk communication by their caregivers . The aim of this study was to investigate the effects of an intervention focused on the communication of the absolute 10-year risk of developing cardiovascular disease ( CVD ) in patients with T2DM . RESEARCH DESIGN AND METHODS A r and omized controlled trial was performed in T2DM patients newly referred to the Diabetes Care System ( DCS ) West-Friesl and , a managed-care system in the Netherl and s. The intervention group ( n = 131 ) received a six-step CVD risk communication .  Control subjects ( n = 130 ) received st and ard managed care . The primary outcome measure was appropriateness of risk perception ( difference between actual CVD risk calculated by the UK Prospect i ve Diabetes Study risk engine and risk perception ) . Secondary outcome measures were illness perceptions , attitude and intention to change behavior , satisfaction with the communication , and anxiety and worry about CVD risk . Patients completed question naires at baseline , at 2 weeks ( immediately after the intervention ) , and at 12 weeks . RESULTS Appropriateness of risk perception improved between the intervention and control groups at 2 weeks . This effect disappeared at 12 weeks . No effects were found on illness perceptions , attitude and intention to change behavior , or anxiety and worry about CVD risk . Patients in the intervention group were significantly more satisfied with the communication . CONCLUSIONS This risk communication method improved patients ’ risk perception at 2 weeks but not at 12 weeks . Negative effects were not found , as patients did not become anxious or worried after the CVD risk communication Objective — General practice visits are a unique opportunity to identify and treat individuals with a high cardiovascular ( CV ) risk . However , a case-finding strategy suited to the daily general practice is not provided in the CV prevention guidelines .We wanted to create , vali date and test an algorithm for global CV risk assessment and management . Methods — The algorithm was 1 ) developed based on evidence from epidemiological studies and clinical trials , 2 ) vali date d in a population -based cohort and 3 ) tested by r and omly selected general practitioners ( GPs ) who rated its usefulness and applicability . Results — 1 ) Screening for seven clinical risk factors ( RF ) allowed a quick classification of patients in four CV risk typologies : obvious high risk ( previous CV event and /or type 2 diabetes ) in 17 % , obvious low risk ( no RF ) in 14 % , smoking-related risk ( single RF ) in 6 % , or undetermined risk ( any other RF ) to further evaluate in 63 % patients . Inter-physician reproducibility for risk prediction was excellent . Overall , predicted risk was high , moderate and low in 25 , 17 and 58 % of the patients , respectively . 2 ) These risk predictions were vali date d in a cohort of 962 men followed over 10 years . 3 ) Most GPs reported that the algorithm was applicable and useful , while half of them started using it frequently in their daily practice . Conclusion — This algorithm is a new , pragmatic and evidence -based strategy for systematic and global CV risk management . It was vali date d at the population level , and shown to be applicable and useful in the daily general practice Introduction : A large proportion of the cardiovascular disease ( CVD ) burden can potentially be prevented by primary prevention programs addressing major causal risk factors . A Web-based health risk assessment ( HRA ) with tailored feedback for individual health promotion is a promising strategy . We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite . Methods : We conducted a prospect i ve follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008 . The program included a multicomponent HRA through a Web-based electronic question naire , biometrics , and laboratory evaluation . The results were combined with health behavior change theory to generate tailored motivational and educational health advice . On request , a health counseling session with the program physician was available . Follow-up data on CVD risk were collected 1 year after initial participation . The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline . We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later . Results : A total of 176 employees completed follow-up measurements after a mean of 7 months . There was a grade d relation between CVD risk changes and baseline risk , with a relative reduction of 17.9 % ( P = 0.001 ) in the high-risk category ( baseline CVD risk ≥20 % ) . Changes were not explained by additional health counseling , medication , or an increase in health consciousness within the company . Conclusions : Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18 % among participants at high CVD risk and by nearly 5 % among all participants . Web-based HRA could improve CVD risk in similar population s. Future research should focus on the persistence of the effects underlying the CVD risk reduction Few data exist on the effectiveness of cardiovascular disease ( CVD ) risk-reduction programs in patients with limited access to health care . The objective of this project was to evaluate a disease management approach to multifactor CVD risk reduction in patients with limited or no health insurance and low family income . Patients ( n = 148 ) were recruited from not-for-profit or free clinics and hospitals and r and omized to usual care or usual care plus team case management . Mean age was 59.3 years , 57 % were women , 50 % had less than a high school education , 57 % were Hispanic , and 64 % had no health insurance . All had > or = 1 increased risk factor for CVD , and 24.5 % had documented coronary artery disease . Follow-up measurements were obtained at 6 and 12 months . Primary outcomes were low-density lipoprotein cholesterol and systolic blood pressure . The disease management program was supervised by a physician , delivered by nurses and dietitians , and included comprehensive lifestyle changes and medications . Data were collected on 91 % of patients at 12 months . Disease management produced clinical ly important decreases in selected risk factors compared with usual care , including systolic blood pressure ( p < 0.01 ) and low-density lipoprotein cholesterol ( p < 0.03 ) . More patients with disease management than those with usual care moved from " high " and " very-high " risk to lower risk categories for selected risk factors . In conclusion , the disease management program had excellent retention and lower CVD risk factors and demonstrated the potential of such approaches for decreasing long-term disease burden in selected medically underserved population PURPOSE We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease ( CVD ) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations . METHODS The study was based on a pragmatic , cluster r and omized controlled trial ( phase III ) with  continuing medical education ( CME ) groups of family physicians  as the unit of r and omization . In the intervention arm , 44 physicians ( 7 CME groups ) consecutively recruited 550 patients in whom cholesterol levels were measured . Forty-seven physicians in the control arm ( 7 CME groups ) similarly included 582 patients . Four hundred sixty patients ( 83.6 % ) of the intervention arm and 466 patients ( 80.1 % ) of the control arm were seen at follow-up . Physicians attended 2 interactive CME sessions and received a booklet , a paper-based risk calculator , and individual summary sheets for each patient . Control physicians attended 1 CME-session on an alternative topic . Main outcome measures were patient satisfaction and participation after the index consultation , change in CVD risk status , and decisional regret at 6 months ’ follow-up . RESULTS Intervention patients were significantly more satisfied with process and result ( Patient Participation Scale , difference 0.80 , P<.001 ) . Decisional regret was significantly lower at follow-up ( difference 3.39 , P = .02 ) . CVD risk decreased in both groups without a significant difference between study arms . CONCLUSION A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret , without negatively affecting global CVD risk Background Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT Background A pilot project cardiovascular prevention was implemented in S and well ( West Midl and s , UK ) . This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease then invited these high risk patients for assessment by a nurse in their own general practice . Those found to be eligible for treatment were offered treatment . During the pilot a higher proportion of high risk patients were started on treatment in the intervention practice s than in control practice s. Following the apparent success of the prevention project , it was intended to extend the service to all practice s across the S and well area . However the pilot project was not a robust evaluation . There was a need for an efficient evaluation that would not disrupt the planned rollout of the project . Methods / design Project nurses will sequentially implement targeted cardiovascular case finding in a phased way across all general practice s , with the sequence of general practice s determined r and omly . This is a stepped wedge r and omised controlled trial design . The target population is patients aged 35 to 74 , without diabetes or cardiovascular disease whose ten-year cardiovascular risk , ( determined from data in their electronic records ) is ≥20 % . The primary outcome is the number of high risk patients started on treatment , because these data could be efficiently obtained from electronic primary care records . From this we can determine the effects of the case finding programme on the proportion of high risk patients started on treatment in practice s before and after implementation of targeted case finding . Cost-effectiveness will be modelled from the predicted effects of treatments on cardiovascular events and associated health service costs . Alongside the implementation it is intended to interview clinical staff and patients who participated in the programme in order to determine acceptability to patients and clinicians . Practical considerations meant that 26 practice s in S and well could be r and omised , including about 6,250 patients at high risk of cardiovascular disease . This gives sufficient power for evaluation . Discussion It is possible to design a stepped wedge r and omised controlled trial using routine data to determine the primary outcome to evaluate implementation of a cardiovascular prevention programme Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk . In this project , we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice . Consumer Navigation of Electronic Cardiovascular Tools ( CONNECT ) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Isl and er and non-indigenous adults , recruited through primary care , at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care . Methods and analysis R and omised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk . The trial will be augmented by formal economic and process evaluations to assess acceptability , equity and cost-effectiveness of the intervention . The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management . The programme is electronically integrated with the primary care provider 's software and will include interactive smart phone and Internet platforms . The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline -recommended blood pressure ( BP ) and cholesterol targets . Secondary outcomes include change in mean BP and fasting cholesterol levels , proportion meeting BP and cholesterol targets separately , self-efficacy , health literacy , self-reported point prevalence abstinence in smoking , body mass index and waist circumference , self-reported physical activity and self-reported medication adherence . Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774
The heterogeneity of the studies limited the analysis , but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety , but had little effect on lifestyle .
There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing , with little evidence of harm on psychological well-being
OBJECTIVE To systematic ally review whether the provision of information on cardiovascular disease ( CVD ) risk to healthcare professionals and patients impacts their decision-making , behaviour and ultimately patient health .