Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care Women’s hearts need special treatment Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care EUROPEAN COLLABORATIVE TRIAL OF MULTIFACTORIAL PREVENTION OF CORONARY HEART DISEASE: FINAL REPORT ON THE 6-YEAR RESULTS Multifactorial trial in the prevention of coronary heart disease: 3. Incidence and mortality results. Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial Rationale and design of a randomized controlled trial evaluating community health worker-based interventions for the secondary prevention of acute coronary syndromes in India (SPREAD). EUROPEAN COLLABORATIVE TRIAL OF MULTIFACTORIAL PREVENTION OF CORONARY HEART DISEASE [Effectiveness of the cooperative program of multifactorial prevention of ischemic heart disease (results of the 3-year study)]. Evaluating the efficacy of an education and treatment program for patients with coronary heart disease. Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: subgroup findings and comparisons with other trials. [The Belgian project for the prevention of cardiovascular diseases: a model of multifactorial prevention]. Examination of a Nurse-led Community-based Education and Coaching Intervention for Coronary Heart Disease High-risk Individuals in China. Quality of care for secondary prevention for patients with coronary heart disease: results of the Hastening the Effective Application of Research through Technology (HEART) trial. The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial
Abstract Objectives : To evaluate the effects of nurse led clinics in primary care on secondary prevention , total mortality , and coronary event rates after four years . Design : Follow up of a r and omised controlled trial by postal question naires and review of case notes and national data sets . Setting : Stratified , r and om sample of 19 general practice s in north east Scotl and . Participants : 1343 patients ( 673 intervention and 670 control ) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound . Intervention : Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year . Main outcome measures : Components of secondary prevention ( aspirin , blood pressure management , lipid management , healthy diet , exercise , non-smoking ) , total mortality , and coronary events ( non-fatal myocardial infa rct ions and coronary deaths ) . Results : Mean follow up was at 4.7 years . Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year , and these were sustained after four years except for exercise . The control group , most of whom attended clinics after the initial year , caught up before final follow up , and differences between groups were no longer significant . At 4.7 years , 100 patients in the intervention group and 128 in the control group had died : cumulative death rates were 14.5 % and 18.9 % , respectively ( P=0.038 ) . 100 coronary events occurred in the intervention group and 125 in the control group : cumulative event rates were 14.2 % and 18.2 % , respectively ( P=0.052 ) . Adjusting for age , sex , general practice , and baseline secondary prevention , proportional hazard ratios were 0.75 for all deaths ( 95 % confidence intervals 0.58 to 0.98 ; P=0.036 ) and 0.76 for coronary events ( 0.58 to 1.00 ; P=0.049 ) Conclusions : Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events .  Secondary prevention clinics should be started sooner rather than later . What is already known on this topic Several effective interventions exist for the secondary prevention of coronary heart disease , but implementing them in practice has proved difficult Secondary prevention programmes for coronary heart disease have improved short term outcomes such as processes of care and quality of life What this study adds Short term improvements in uptake of secondary prevention produced by nurse led clinics are maintained in the longer term Improved medical and lifestyle components of secondary prevention produced by nurse led clinics seem to lead to fewer total deaths and coronary Coronary heart disease ( CHD ) is the leading cause of death for both men and women in the Western world . Some studies show that the observed decline in cardiovascular mortality is not as pronounced among women as among men . There is a growing awareness that most earlier studies both on primary and secondary risk factors , diagnosis , prognosis , and rehabilitation have focused mainly on men . Thus , there is a need to develop knowledge about women with CHD and to address gender issues in treatment and rehabilitation strategies . Negative affect and emotions increase risk and may interfere with effective cardiac rehabilitation . Therefore , methods for coping with emotional stress need to be included in treatment regimens after a coronary event . The feasibility of a stress management program for women with CHD was assessed in a pilot study . The program consisted of twenty 2-hr group sessions during 1 year , with 5 to 9 participants per group . The pilot study showed that this treatment program had a low dropout rate and result ed in improvement in quality of life and reduction in stress and symptoms . Further work to optimize psychosocial interventions for women with CHD is needed Objectives : To evaluate the effects of nurse-led secondary prevention clinics for coronary heart disease ( CHD ) in primary care on total mortality and coronary event rates after 10 years . Design : Follow-up of a r and omised controlled trial by review of national data sets . Setting : Stratified r and om sample of 19 general practice s in northeast Scotl and . Participants : Original study cohort of 1343 patients , aged < 80 years , with a working diagnosis of CHD , but without dementia or terminal illness and not housebound . Intervention : Nurse-led secondary prevention clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow-up for 1 year , Main outcome measures : Total mortality and coronary events ( non-fatal myocardial infa rct ions ( MIs ) and coronary deaths ) . Results : Mean ( SD ) follow-up was at 10.2 ( 0.19 ) years . No significant differences in total mortality or coronary events were found at 10 years . 254 patients in the intervention group and 277 patients in the control group had died : cumulative death rates were 38 % and 41 % , respectively ( p = 0.177 ) . 196 coronary events occurred in the intervention group and 195 in the control group : cumulative event rates were 29.1 % and 29.1 % , respectively ( p = 0.994 ) . When Kaplan – Meier survival analysis , adjusted for age , sex and general practice , was used , proportional hazard ratios were 0.88 ( 0.74 to 1.04 ) for total mortality and 0.96 ( 0.79 to 1.18 ) for coronary death or non-fatal MI . No significant differences in the distribution of cause of death classifications was found at either 4 or 10 years . Conclusions : After 10 years , differences between groups were no longer significant . Total mortality survival curves for the intervention and control groups had not converged , but the coronary event survival curves had . Possibly , therefore , the earlier that secondary prevention is optimised , the less likely a subsequent coronary event is to prove fatal In a r and omised controlled evaluation of multifactorial prevention of coronary heart disease ( CHD ) among 60 881 men employed in 80 factories in Belgium , Italy , Pol and , and the UK intervention was associated with reductions of 10.2 % in total CHD , 6.9 % in fatal CHD , 14.8 % in non-fatal myocardial infa rct ion , and 5.3 % in total deaths , with a neutral result for non-CHD deaths . Benefit was significantly related to the extent of risk factor change . The observed reduction in total CHD was 62 % of that predicted by means of a multiple logistic function summary of risk factor changes . Advice on risk factor reduction in middle-aged men is effective to the extent that it is accepted and it appears to be safe Incidence and mortality results are presented from an international controlled trial of multifactorial prevention of coronary heart disease , involving r and omization of 66 factories ( 49 781 men ) in U.K. , Belgium , Italy and Pol and ( Cracow ) . Results for Pol and ( Warsaw ) are not yet complete . Net average reductions in risk factors ( all subjects ) were 1.2 % for plasma cholesterol , 8.9 % for daily cigarettes , 0.4 % for weight , 2.0 % for systolic blood pressure , and 11.1 % for a combined risk estimate . Greater reductions occurred in high-risk subjects ( 19.4 % for the combined estimate ) . The net overall reduction in CHD rates was 7.4 % ( 95 % confidence interval -29 to + 15 % ) for deaths ( 722 cases ) , and 3.9 % ( 95 % confidence interval -10 to + 2 % ) for fatal CHD + non-fatal myocardial infa rct ion ( 1502 cases ) . Among men aged 40 - 49 the reduction for this end-point was 15 % ; at ages 50 - 59 there was a small net increase . All-causes deaths after an early adverse trend showed 2.7 % reduction overall . There were large differences between centres , ranging from a 5 % net increase in CHD for U.K. to a decrease of 24 % in Belgium . In Belgium the decrease both in CHD and in all deaths was significant at the 5 % level . The effect on CHD in the different centres correlated broadly with their changes in risk factors . It is concluded that reduction in major coronary risk factors in industrial population s is possible , but it depends on adequate re sources ; the results support the hypotheses that CHD risk in middle-aged men is reversible and that community intervention can be beneficial Aims : To evaluate the effect of a disease management programme for patients with coronary heart disease ( CHD ) and chronic heart failure ( CHF ) in primary care . Methods : A cluster r and omised controlled trial of 1316 patients with CHD and CHF from 20 primary care practice s in the UK was carried out . Care in the intervention practice s was delivered by specialist nurses trained in the management of patients with CHD and CHF . Usual care was delivered by the primary healthcare team in the control practice s. Results : At follow up , significantly more patients with a history of myocardial infa rct ion in the intervention group were prescribed a beta-blocker compared to the control group ( adjusted OR 1.43 , 95 % CI 1.19 to 1.99 ) . Significantly more patients with CHD in the intervention group had adequate management of their blood pressure ( < 140/85 mm Hg ) ( OR 1.61 , 95 % CI 1.22 to 2.13 ) and their cholesterol ( < 5 mmol/l ) ( OR 1.58 , 95 % CI 1.05 to 2.37 ) compared to those in the control group . Significantly more patients with an unconfirmed diagnosis of CHF had a diagnosis of left ventricular systolic dysfunction confirmed ( OR 4.69 , 95 % CI 1.88 to 11.66 ) or excluded ( OR 3.80 , 95 % CI 1.50 to 9.64 ) in the intervention group compared to the control group . There were significant improvements in some quality -of-life measures in patients with CHD in the intervention group . Conclusions : Disease management programmes can lead to improvements in the care of patients with CHD and presumed CHF in primary care BACKGROUND There is a need to evaluate and implement cost-effective strategies to improve adherence to treatments in coronary heart disease . There are no studies from low- to middle income countries ( LMICs ) evaluating trained community health worker (CHW)-based interventions for the secondary prevention of coronary heart disease . METHODS We design ed a hospital-based , open r and omized trial of CHW-based interventions versus st and ard care .  Patients after an acute coronary syndrome ( ACS ) were r and omized to an intervention group ( a CHW-based intervention package , comprising education tools to enhance self-care and adherence , and regular follow-up by the CHW ) or to st and ard care for 12 months during which study outcomes were recorded . The CHWs were trained over a period of 6 months . The primary outcome measure was medication adherence . The secondary outcomes were differences in adherence to lifestyle modification , physiological parameters ( blood pressure [ BP ] , body weight , body mass index [ BMI ] , heart rate , lipids ) , and major adverse cardiovascular events . RESULTS We recruited 806 patients stabilized after an ACS from 14 hospitals in 13 Indian cities . The mean age was 56.4 ( ± 11.32 ) years , and 17.2 % were females . A high prevalence of risk factors such as hypertension ( 43.4 % ) , diabetes ( 31.9 % ) , tobacco consumption ( 35.4 % ) , and inadequate physical activity ( 70.5 % ) was documented . A little over half had ST-elevation myocardial infa rct ion ( 53.7 % ) , and 46.3 % had non-ST-elevation myocardial infa rct ion or unstable angina . CONCLUSION The CHW interventions and training for SPREAD have been developed and adapted for local use . The results and experience of this study will be important to counter the burden of cardiovascular diseases in low- to middle income countries Results are reported from a trial of multifactorial prevention of coronary heart disease ( CHD ) in occupational groups , involving r and omization of 66 factories to intervention and control ( 49,781 men ages 40 to 59 ) in the United Kingdom , Belgium , Italy , and Pol and . Net average reductions in the intervention factors were 1.2 % ( plasma cholesterol ) , 8.9 % ( daily cigarettes ) , 0.4 % ( weight ) , 2 % ( systolic blood pressure ) , and 11 % for a combined risk estimate . Reductions were larger in high-risk men ( 19 % for the combined estimate ) . Red blood cell fatty acid profiles were substantially changed . There was a net overall reduction of 7.4 % in fatal CHD and 2.7 % in total deaths . Benefits were larger in centers achieving larger risk factor reductions , and in one country -- Belgium -- the net decreases in CHD incidence and total deaths were significant at the 5 % level . Benefit was at least as great in men with established ECG abnormality . It is concluded that CHD risk in middle-aged men seems to be reducible by simple and cost-effective means The paper provides the results obtained in the course of the cooperative All-Union programme on multifactor prevention of coronary heart disease ( CHD ) , which has been implemented over 3 years to examine the efficiency of preventive actions aim ed at correcting the levels of CHD risk factors . The study was conducted in 6 centers of the country among a non-organized male population aged 40 - 59 years . The outcome of the preventive measures , largely nonpharmacological ones , made during 3 years suggests that the prevalence of the major CHD risk factors may be reduced in the population . The preventive actions are the most beneficial in arterial hypertension and smoking BACKGROUND Until now , there has not been any evaluated , disease-specific education and treatment program for patients with coronary heart disease ( CHD ) in Germany . It is thought that education can improve these patients ' physical activity and quality of life and teach them how to lessen their risk factors , what to do in case of an emergency , and how to assess their own medical treatment . METHODS A r and omized controlled open intervention trial was carried out from February 2010 to September 2011 . 196 patients were assigned to receive the intervention ( patient education ) , while 199 were assigned to a control group .  In an intention-to-treat analysis , baseline and follow-up data were compared after a mean interval of 220 days . The evaluative instruments included the Freiburg Question naire of Physical Activity , the MacNew Heart Disease Quality of Life Question naire , question naires regarding knowledge about CHD , ergometric performance ability , and the body-mass index . RESULTS The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week ( MET = metabolic equivalent of task ) , compared to 2.5 MET/week in the control group ; the difference of 6.8 MET/week was statistically significant ( p = 0.015 ) . The patients in the intervention group also rated their quality of life higher than those in the control group ( 0.2 ± 0.56 vs. 0.09 ± 0.53 [ mean ± st and ard deviation ] , p = 0.056 ) . They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency . CONCLUSION Persistently unhealthy lifestyle is a common problem of CHD patients ; the education and treatment program presented here may be a suitable means of improving patients ' lifestyle for secondary prevention . Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males The Multiple Risk Factor Intervention Trial was a r and omized clinical study to test whether a special-intervention ( SI ) program aim ed at reducing serum cholesterol levels , blood pressure and cigarette smoking would prevent coronary heart disease ( CHD ) in middle-aged men . The main endpoint reported here is the percentage of participants experiencing first major CHD events ( either nonfatal acute myocardial infa rct ion [ AMI ] or CHD death ) during 7 years of follow-up . This outcome was slightly less frequent in the 6,428 SI men than in the 6,438 men assigned to their usual source of care ( UC ) . However , the relative difference -- either 1 % ( 95 % confidence interval -17 % to 16 % ) or 8 % ( 95 % confidence interval -5 % to 20 % ) , depending on how AMI was classified -- was not statistically significant . Regression analyses within the SI and UC groups suggested that the cholesterol and cigarette smoking interventions reduced the number of first major CHD events : the associations between lowering the levels of these 2 factors and reductions in CHD rates were significant ( p less than 0.001 ) and of the anticipated magnitude . A similar analysis of antihypertensive treatment in the SI group revealed no favorable association between lowering blood pressure and CHD rate , and other subgroup comparisons suggested that a mixture of beneficial and adverse effects may underlie this finding . Thus , the nonsignificant overall UC/SI contrast in CHD rates may reflect a combination of the expected beneficial effects of the cholesterol and smoking interventions with unexpected heterogeneous effects of the antihypertensive intervention . Seven of 8 other prespecified cardiovascular endpoints occurred less frequently among SI than among UC men , the difference being nominally significant ( p less than 0.05 ) for angina pectoris , congestive heart failure and peripheral arterial disease The Multiple Risk Factor Intervention Trial ( MRFIT ) was a r and omized primary prevention trial to test whether a special intervention ( SI ) program to reduce high blood pressure , elevated blood cholesterol , and /or cigarette smoking could lower  coronary heart disease ( CHD ) mortality in middle-aged men at above average risk . After an average follow-up period of 7 years , risk factor levels were reduced substantially more in SI than in usual-care ( UC ) men ; however , SI-UC differences in CHD mortality ( 7.1 % ) and total mortality ( -2.1 % ) were not statistically significant . Subgroup analysis showed 35 % fewer SI than UC CHD deaths ( P = 0.14 ) but no all-causes mortality difference in men comparable to the cohort having dietary and smoking intervention in Oslo ( the " Oslo-like " cohort ) . Among the subgroup hypertensive at entry , SI-UC differences in CHD and total mortality appeared to be heterogeneous : CHD mortality was 24 % lower in SI than UC men with a normal resting ECG at baseline , but 67 % higher if baseline ECG abnormalities were present ( nominal P = 0.02 , for difference in relative risk estimates ) . These findings were supported by within-group analyses and are generally consistent with results of other CHD/cardiovascular disease prevention trials . They pose a new hypothesis about possible adverse effects of diuretic therapy in a minority of the hypertensive population Résults are presented from the " belgian heart disease prevention project , part of the WHO european collaborative trial in the multifactorial prevention of coronary heart disease ( CHD ) " . 19.409 men aged 40 - 59 yr took part ; they were employed in thirty factories which formed the allocation units for a r and omised controlled trial lasting 5 - 6 yr . The intervention package consisted largely of health education promoting a cholesterol-lowering diet , smoking cessation , weight control , physical activity , and treatment of arterial hypertension . A programme of information was supplemented by face-to-face counselling at the workplace by two physicians attached to the project . The coronary risk profile was reduced in the intervention group , compared with that in the control group , especially during the first 4 yr , by effects on serum cholesterol , number of cigarettes smoked daily , and arterial blood-pressure . Total mortality was 17.5 % lower in the intervention group than in the control group ( p = 0.038 ) ; coronary mortality was reduced by a non-significant 20.8 % whereas CHD incidence ( non-fatal myocardial infa rct ion plus fatal myocardial infa rct ion plus sudden deaths ) was reduced by 24.5 % , ( P = 0.031 ) . Non-fatal myocardial infa rct ion ( not a major end-point ) was similarly reduced by 26.1 % ( p = 0.030 ) PURPOSE Early detection and management of coronary heart disease ( CHD ) are embedded into many community health service and primary care practice s in western countries . The Framingham CHD risk score has been used to predict CHD and mortality for nearly 20 years , and it has predicted CHD event risk accurately in multiethnic population s. The aim of this study was to access the effect of a 6-month community-based intervention on CHD risk in individuals at high risk . METHODS A r and omized controlled trial of individuals with a high 10-year CHD risk were recruited from two communities in China . Individuals in the intervention group ( n = 53 ) received a 3-month group education and a 3-month coaching session . Physical examination and self-report question naires were used to collect both pre- and postintervention data on blood pressure , glucose , cholesterol , body mass index , smoking , depression , and health-related quality of life ( HRQoL ) . RESULTS A total of 102 participants ( 85.0 % ) completed the 6-month study . Compared with the usual care group , the intervention group had a 5 mmHg greater reduction in systolic blood pressure ( t = 2.01 , p = .047 ) , larger declines in glucose ( t = -2.49 , p = .015 ) , cholesterol ( t = -2.44 , p = .017 ) , body mass index ( t = -2.58 , p = .011 ) , and depression ( t = -2.05 , p = .043 ) , and better reports of HRQoL ( t = 3.36 , p = .001 ) . No significant group differences in smoking behaviors were reported . CONCLUSION A 6-month  community-based intervention in a CHD high-risk population improved disease-related risk factors , depression , and HRQoL. Results provide preliminary evidence for primary prevention of cardiovascular disease risk in a community high-risk population BACKGROUND Effective therapies for reducing mortality rates in persons with coronary heart disease ( CHD ) remain underused . We report the results of an effectiveness trial of a quality improvement effort to increase the use of 3-hydroxy-3methylglutaryl coenzyme A ( HMG CoA ) reductase inhibitors , beta-blockers , and angiotensin-converting enzyme ( ACE ) inhibitors in patients with CHD in a network-model managed-care setting . METHODS Patients with CHD were identified by search ing a cl aims data base . The use of therapies was assessed by linkage with a pharmacy data base . An intervention , consisting of a guideline summary , peer comparison performance feedback , and patient specific chart reminders was evaluated in a r and omized , practice -based effectiveness trial . RESULTS Data were available for > 700 patients per year ( 1999 - 2002 ) in 131 practice s. At baseline ( 1999 ) , 55 % of patients were receiving HMG CoA reductase inhibitors , 39 % of patients were receiving beta-blockers , and 24 % of patients were receiving ACE inhibitors . The use of all 3 types of medications increased steadily with time , with the exception of a decrease in the use of HMG CoA reductase inhibitors in the final year ( 2002 ) . No difference in medication use was observed between r and omized groups . CONCLUSIONS The observed pattern of care supports the contention that the quality of outpatient care for secondary prevention of CHD improved from 1999 to 2002 in this setting . The basis for the inconsistent pattern of use of HMG CoA reductase inhibitors is not certain , but may relate to concerns about toxicity . Central ized mailings of guideline summaries , performance feedback reports , and chart reminders had no observable impact on quality of care in this setting . More intensive intervention may be required to improve the quality of outpatient care for the secondary prevention of CHD Abstract Background Coronary heart disease ( CHD ) is the most prevalent type of cardiac disease among adults worldwide , including those in Singapore . Most of its risk factors , such as smoking , physical inactivity and high blood pressure , are preventable . mHealth has improved in the last decade , showing promising results in chronic disease prevention and health promotion worldwide . Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention ( SBCHDP ) programme in improving awareness and knowledge of CHD , perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore . Methods The smartphone app “ Care4Heart ” was developed as the main component of the programme . App content was review ed and vali date d by a panel of experts , including two cardiologists and two experienced cardiology-trained nurses . A pilot r and omised controlled trial was conducted . Eighty working people were recruited and r and omised to either the intervention group ( n = 40 ) or the control group ( n = 40 ) . The intervention group underwent a 4-week SBCHDP programme , whereas the control group were offered health promotion websites only . The participants ’ CHD knowledge , perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Question naire-2 , Perceived Stress Scale , and Behavioural Risk Factor Surveillance System . Results After the SBCHDP programme , participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore ( X2 = 6.486 , p = 0.039 ) , a better overall CHD knowledge level ( t = 3.171 , p = 0.002 ) , and better behaviour concerning blood cholesterol control ( X2 = 4.54 , p = 0.033 ) than participants in the control group . Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population . Due to the small sample size and short follow-up period , this study was underpowered to detect significant differences between groups . A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme
Multifactorial lifestyle interventions aim ed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events .
Therefore , they may have added value in secondary prevention of CHD
CONTEXT Coronary heart disease ( CHD ) is responsible for about 15 % of all deaths worldwide and is identified as a top priority for decision makers .
Both primary and secondary prevention are considered key strategies in the prevention of CHD .
The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care .