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EUROACTION
     A European Demonstration
  Project in Preventive Cardiology

Implications of EUROACTION
  for preventive c...
EUROACTION
8 countries 24 centres 8657 subjects
Generalisable model of
preventive cardiology care
Includes all priority
           patient groups

    Coronary patients and their families

Relatives of coronary patients ...
Index event of patients attending
         initial assessment by gender


  Men                          Women



31%     ...
Classification of high risk patients



                              SCORE
       36%         34%
                       ...
Equity of access to preventive
    cardiology programmes
Participation & Completion

          Hospital                       Primary Care

               Patients Partners       ...
The Family approach
Proportions of patients achieving
                               the European targets for a
                              ...
Proportions of partners achieving
                         the European targets for a
                    Hospital
       ...
Nurse-led
multidisciplinary teams
Nurse-led multi-disciplinary
hospital and primary care teams


   Cardiovascular prevention nurses
              Dietician...
Comprehensive lifestyle
   risk factor and therapeutic
           intervention

  Lifestyle: tobacco, healthy eating and
 ...
Proportion of patients achieving
                    European Guidelines for physical
                                acti...
Proportion of partners achieving
              European Guidelines for physical
                          activity
       ...
Comprehensive lifestyle
   risk factor and therapeutic
           intervention

  Lifestyle: tobacco, healthy eating and
 ...
Proportion of patients achieving
                         the European target for
                               blood pre...
Therapeutic control of
                              blood pressure
                       Hospital                       ...
Comprehensive lifestyle
   risk factor and therapeutic
           intervention

  Lifestyle: tobacco, healthy eating and
 ...
Proportion of patients on
                                            cardiovascular protective
                          ...
Cluster Randomised Control Trial
                  Statistical power
    o    Statistical power was reduced because of
   ...
Conclusions

            EUROACTION has set
a new benchmark for standards of preventive
                 cardiology care
 ...
EUROACTION
                 Steering Group
   Professor Guy de Backer, Professor Dirk De Bacquer ,
  Professor Martin Buxt...
EUROACTION
            Steering Group
National Co-ordinators and Primary Care
                 Leads
       Dr Troels Thom...
EUROACTION
   Co-ordinating and Data Management Centre
Cardiovascular Medicine, National Heart and Lung Institute,
       ...
The London
                   Co-ordinating Team
• Dr Kornelia Kotseva, Senior Research Fellow
• Dr Susan Connolly, Consul...
Denmark

• Dr Troels Thomsen, National Co-ordinator
• Dr Kim Brockelmann, Primary Care Lead         Dr Troels Thomsen
    ...
France
Dr Catherine Monpere, National Co-ordinator
Institut Hospitalier Jacques Cartier
Dr Bertrand Cormier, Principal Inv...
Italy
Professor Paolo Fioretti, National Co-ordinator
Dr Alessandro Desideri , National Co-ordinator
Professor Silvio Brus...
The Netherlands
• Associate Professor Trudy van der
Weijden (National Co-ordinator and
Primary Care Lead)
• Health care ce...
Poland
Professor Andrzej Pajak, National Co-ordinator
Dr Piotr Jancowsky, National Co-ordinator
Professor Tomasz Grodzicki...
Spain
Professor Jose de Velasco National Co-
ordinator
Dr Antonio Maiques Prmary Care Lead
Hospital General Dr Peset Valen...
Sweden
Professor Joep Perk, National
Co-ordinator
Medicinkliniken Halmstad Sjukhus
Dr Peter Hardhammar, Principal
Investig...
UK
Professor David Wood, National
Co-ordinator
Dr Jonathan Morrell, Primary Care Lead
Dr Punit Ramrakha, Principal Investi...
EUROACTION
 A European Society of Cardiology
 demonstration project in preventive
              cardiology
          solel...
EUROACTION, A European Society of Cardiology Demonstration ...
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Transcript of "EUROACTION, A European Society of Cardiology Demonstration ..."

  1. 1. EUROACTION A European Demonstration Project in Preventive Cardiology Implications of EUROACTION for preventive cardiology Professor David Wood on behalf of the EUROACTION Group
  2. 2. EUROACTION 8 countries 24 centres 8657 subjects
  3. 3. Generalisable model of preventive cardiology care
  4. 4. Includes all priority patient groups Coronary patients and their families Relatives of coronary patients with premature CHD Healthy individuals at high multifactorial risk (SCORE > 5% over 10 years) of developing CVD, or hypertension/dyslipidaemia, or diabetes, and their families
  5. 5. Index event of patients attending initial assessment by gender Men Women 31% AMI 41% AMI 45% 51% UA UA SA SA 18% 14%
  6. 6. Classification of high risk patients SCORE 36% 34% BP & Lipids Diabetes 30%
  7. 7. Equity of access to preventive cardiology programmes
  8. 8. Participation & Completion Hospital Primary Care Patients Partners Patients Partners Participated 1060 637 Participated 943 233 in (67%) in EuroAction (77%) (87%) (74%)* EuroAction programme programme Completed 895 438 Completed 888 225 EuroAction EuroAction programme (84%) (69%) programme (94%) (97%)* *of those who agreed to participate
  9. 9. The Family approach
  10. 10. Proportions of patients achieving the European targets for a healthy diet Hospital General Practice 90 90 p = 0.004 80 80 p = 0.005 70 p = 0.91 70 p = 0.009 p = 0.26 60 78 72 60 50 50 40 55 56 55 54 40 30 40 p = 0.04 46 30 39 p = 0.13 20 35 20 10 16 10 8 11 6 0 0 Saturated fat < Fruits and Fish > 20 g/day Oily fish > 3 Fruits and Fish > 20 g/day Oily fish > 3 10% of total vegetables >400 times/week vegetables >400 times/week energy g/day g/day Intervention Usual Care
  11. 11. Proportions of partners achieving the European targets for a Hospital healthy diet General Practice 90 90 p = 0.002 80 p = 0.002 80 p = 0.31 70 70 p = 0.42 77 60 p = 0.98 60 72 50 50 60 54 40 55 40 52 42 51 45 30 30 p = 0.09 20 37 p = 0.77 20 10 11 8 10 20 0 0 7 Saturated fat < Fruits and Fish > 20 g/day Oily fish > 3 Fruits and vegetables Fish > 20 g/day Oily fish > 3 10% of total vegetables >400 times/week >400 g/day times/week energy g/day Intervention Usual Care
  12. 12. Nurse-led multidisciplinary teams
  13. 13. Nurse-led multi-disciplinary hospital and primary care teams Cardiovascular prevention nurses Dieticians Physiotherapists Cardiologists General practitioners
  14. 14. Comprehensive lifestyle risk factor and therapeutic intervention Lifestyle: tobacco, healthy eating and physical activity Other risk factors: overweight and obesity, blood pressure, lipids and glucose Cardioprotective drug therapies
  15. 15. Proportion of patients achieving European Guidelines for physical activity Hospital General Practice 60 + 36% (+20% to + 51%) 60 + 29% ( + 11% to + 48%) 50 50 54 40 40 50 30 30 20 20 20 22 10 10 0 0 Intervention Usual Care Intervention Usual Care P = 0.002 P = 0.001
  16. 16. Proportion of partners achieving European Guidelines for physical activity Hospital General Practice + 19% (- 0.6% to + 38%) + 27% (+ 4% to + 50%) 50 50 40 40 44 41 30 30 20 20 27 25 10 10 0 0 Intervention Usual Care Intervention Usual Care P = 0.06 p = 0.03
  17. 17. Comprehensive lifestyle risk factor and therapeutic intervention Lifestyle: tobacco, healthy eating and physical activity Other risk factors: overweight and obesity, blood pressure, lipids and glucose Cardioprotective drug therapies
  18. 18. Proportion of patients achieving the European target for blood pressure (< 140/90 mm Hg [<130/85 mm Hg in patients with diabetes mellitus]) Hospital General Practice + 10% (+ 20% to + 0.6%) + 17% (+ 32% to + 2%) 70 70 60 60 50 65 50 40 55 58 40 30 30 41 20 20 10 10 0 0 Intervention Usual Care Intervention Usual Care P = 0.04 p = 0.03 Intervention Usual Care
  19. 19. Therapeutic control of blood pressure Hospital General Practice No drugs: + 14% (+ 33% to - 4%) No drugs: +17% (+32% to +4%) Drugs: + 8 % (+19% to - 4%) Drugs: + 17% (+ 33% to +2%) 90% 70% 80% 60% 70% 65 79 50% 60% 50% 64 40% 52 40% 30% 45 52 47 30% 35 20% 20% 10% 10% 0% 0% No drugs Drugs No drugs Drugs Intervention p = 0.10 no drugs p = 0.02 no drugs Usual Care p = 0.14 with drugs p = 0.04 with drugs
  20. 20. Comprehensive lifestyle risk factor and therapeutic intervention Lifestyle: tobacco, healthy eating and physical activity Other risk factors: overweight and obesity, blood pressure, lipids and glucose Cardioprotective drug therapies
  21. 21. Proportion of patients on cardiovascular protective drug therapy Hospital General Practice 100 p=0.004 p=0.002 100 90 p=0.02 90 80 93 80 70 p=0.98 86 70 60 74 76 60 68 50 67 50 p=0.03 40 52 p=0.51 40 p=0.07 p=0.03 51 30 30 p=0.90 38 20 20 33 29 p=0.21 10 21 18 10 19 17 16 20 23 13 10 0 0 9 8 Anti-platelet Beta ACE Ca Statins Anti- Diuretics B-blockers ACE CA Statins drugs blockers inhibitors antagonists platelet drugs Intervention Usual Care
  22. 22. Cluster Randomised Control Trial Statistical power o Statistical power was reduced because of patient numbers and heterogeneity in the differences between intervention and usual care between countries Under estimation Usual care was being audited o o One quarter of usual care patients were clinically assessed at baseline o One fifth of patients in usual care received cardiac rehabilitation Over estimation o Selective drop out - patients in intervention did not attend at one year
  23. 23. Conclusions EUROACTION has set a new benchmark for standards of preventive cardiology care for coronary and high risk patients and their families in everyday clinical practice
  24. 24. EUROACTION Steering Group Professor Guy de Backer, Professor Dirk De Bacquer , Professor Martin Buxton, Professor Ian Graham, Mr Alan Howard, Dr Kornelia Kotseva, Ms Susanne Logstrup, Professor Hannah McGee, Ms Muriel Mioulet, Dr Karen Smith, Professor David Thompson, Professor David Wood National Co-ordinators & Primary Care Leaders
  25. 25. EUROACTION Steering Group National Co-ordinators and Primary Care Leads Dr Troels Thomsen (National co-ordinator) Dr Kim Brockelmann (Primary Care leader) Denmark Dr Catherine Monpere (National co-ordinator) France Professor Paolo Fioretti (National co-ordinator) Dr Alessandro Desideri (Deputy Co-ordinator) Professor Silvio Brusaferro (Primary Care leader) Italy Professor Andrzej Pajak (National co- ordinator) Dr Piotr Jankowski (Deputy Co-ordinator) Professor Tomasz Grodzicki (Primary Care leader) Poland Professor Jose de Velasco (National co-ordinator) Dr Antonio Maiques (Primary Care leader) Spain Professor Joep Perk (National co-ordinator) Sweden Assoc. Professor Trudy van der Weijden (Primary Care leader) The Netherlands Professor David Wood (National co-ordinator) Dr Jonathan Morrell (Primary Care leader) United Kingdom
  26. 26. EUROACTION Co-ordinating and Data Management Centre Cardiovascular Medicine, National Heart and Lung Institute, Medical Faculty, Imperial College, London, UK Dr Kornelia Kotseva (senior clinical research fellow) Dr Susan Connolly (consultant cardiologist) Ms Catriona Jennings (study nurse co-ordinator) Ms Alison Mead (chief dietician) Ms Jennifer Jones (superintendent physiotherapist) Ms Annie Holden (physical activity specialist) Mr Kamal Pandya (data manager) Ms Sally Graves (research administrator) Professor Ole Faergeman Professor David Wood (Chairman) Statistical Centre Department of Public Health, Ghent University, Ghent, Belgium Professor Dirk De Bacquer, Professor Guy De Backer (Chairman) Laboratory Centre Department of Pathological Biochemistry, Royal Infirmary, Glasgow, Scotland Professor Jim Shephard (Chairman)
  27. 27. The London Co-ordinating Team • Dr Kornelia Kotseva, Senior Research Fellow • Dr Susan Connolly, Consultant Cardiologist • Ms Catriona Jennings, Nurse Co-ordinator • Ms Sally Graves , Study Administrator • Ms Alison Mead, Dietitian • Ms Jenni Jones, Physiotherapist • Ms Annie Holden, Physical Activity Expert • Mr Kamal Pandya, Data Manager
  28. 28. Denmark • Dr Troels Thomsen, National Co-ordinator • Dr Kim Brockelmann, Primary Care Lead Dr Troels Thomsen National Co-ordinato • Sundhedscenteret, Skanderborg • Dr Lisbeth Rosborg, Principal Investigator • Susanne Holck Mogensen • General Practice, Gasvej, Horsens • Dr Henrik Zanoni, Principal Investigator • Lene Henriksen
  29. 29. France Dr Catherine Monpere, National Co-ordinator Institut Hospitalier Jacques Cartier Dr Bertrand Cormier, Principal Investigator Mme Evelyne Brandon Anne-Claire Darcy Valerie Bourniort Alberto Chivite Larzabel Centre Hospitalier Yves Le Foll Dr Benoit Moquet, Principal Investigator Francoise Langlais
  30. 30. Italy Professor Paolo Fioretti, National Co-ordinator Dr Alessandro Desideri , National Co-ordinator Professor Silvio Brusaferro, Primary Care Lead Dr Bortolo Martini, Principal Investigator Dr Enzo Apolloni Marila Meroni Rudi Longhi Valeria Munaretto Anna Sartori Sforza Anna d’Adam Dr Carlo Sponzilli, Principal Investigator Sonia Vivan Dr Beppino Colle, Principal Investigator Dr Massimiliano Rugolo Tilla Gurisatti Dr Mario Casini Principal Investigator Dr Fabrizio Gangi, Lead GP Daniela Gurisatti
  31. 31. The Netherlands • Associate Professor Trudy van der Weijden (National Co-ordinator and Primary Care Lead) • Health care centre Hoensbroek • Dr Martijn van Nunen (Principal Investigator) • Dr Bem Bruls • Jasja Janssen • Health Care Centre Neerbeek • Dr Mieke Winten-Huisman (Principal Investigator) • Dr Marc Eyck (Principal Investigator) • Renee Van De Heuvel • Claudia Geesing
  32. 32. Poland Professor Andrzej Pajak, National Co-ordinator Dr Piotr Jancowsky, National Co-ordinator Professor Tomasz Grodzicki, Primary Care Lead Dr Isabella Kielbalska, Principal Investigator Dr Jacek Nowak, Principal Investigator Renata Wolfhaut Ewa Dojka Anna Nowacka Urzula Biela Anna Rak Dr Elzbieta kluczewska, Principal Investigator Dr Arkadiusz Kaleta Dr Slavomir Surowiec Dr Krystyna Pajak, Principal Investigator Dr Joanna Sładek-Ratajewicz Barbara Waligóra Irena Smarzyńska Dr Maria Fornal, Principal Investigator Helena Kamińska Barbara Wojtanis
  33. 33. Spain Professor Jose de Velasco National Co- ordinator Dr Antonio Maiques Prmary Care Lead Hospital General Dr Peset Valencia Dr Antonio Salvador Principal Investigator Dr Ricardo Salom Cristina Buigues Ana Bonet Arancha Ruescas Rosario Cuevas Hospital General Alicante Dr Fransisco Sogorb Principal Investigator Isabel Lillo Monica Gonzalez Gutierrez Centro de Salud San Pau, Valencia Dr Jorge Navarro Principal Investigator Gemma Méndez Pérez Centro de Salud de Manises
  34. 34. Sweden Professor Joep Perk, National Co-ordinator Medicinkliniken Halmstad Sjukhus Dr Peter Hardhammar, Principal Investigator Dr Per Anders Johansson, Principal Investigator Lisa Andersson Gunilla Sternheden Jessica Andersson Ulla Palmkvist Elin Svensson Medicinkliniken Uddevalla sjukhus Dr Klas Bunner, Principal Investigator Yvonne Brandstrom
  35. 35. UK Professor David Wood, National Co-ordinator Dr Jonathan Morrell, Primary Care Lead Dr Punit Ramrakha, Principal Investigator Rob Harteveldt Christine Rallison Donna Chabanne Jenny Ottaway Lesley Simpson Dr Brian Gould, Principal Investigator Dr Nikhil Parchuri, Principal Investigator Angie Sutcliffe Dr Michal Zabojszcz Dr Tim Gietzen, Principal Investigator Sjouke Ashton Dr Ian McNaughton, Principal Investigator Shirley Colvin
  36. 36. EUROACTION A European Society of Cardiology demonstration project in preventive cardiology solely sponsored by an unconditional educational grant from AstraZeneca www.escardio.org/euroaction
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