Author + information
- Received March 14, 2017
- Revision received May 15, 2017
- Accepted May 16, 2017
- Published online July 10, 2017.
- Madelon Minneboo, MDa,
- Sangeeta Lachman, MDa,
- Marjolein Snaterse, MScb,
- Harald T. Jørstad, MD, PhDa,
- Gerben ter Riet, MD, PhDc,
- S. Matthijs Boekholdt, MD, PhDa,
- Wilma J.M. Scholte op Reimer, PhDa,b,
- Ron J.G. Peters, MD, PhDa,∗ (, )
- on behalf of the RESPONSE-2 Study Group
- aDepartment of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
- bACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- cDepartment of General Practice, Academic Medical Center, Amsterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Ron J.G. Peters, Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Background Among patients with coronary artery disease (CAD), improvement of lifestyle-related risk factors (LRFs) reduces cardiovascular morbidity and mortality. However, modification of LRFs is highly challenging.
Objectives This study sought to evaluate the impact of combining community-based lifestyle programs with regular hospital-based secondary prevention.
Methods The authors performed a randomized controlled trial of nurse-coordinated referral of patients and their partners to 3 widely available community-based lifestyle programs, in 15 hospitals in the Netherlands. Patients admitted for acute coronary syndrome and/or revascularization, with ≥1 LRF (body mass index >27 kg/m2, self-reported physical inactivity, and/or smoking) were included. All patients received guideline-based usual care. The intervention was based on 3 lifestyle programs for weight reduction, increasing physical activity, and smoking cessation. The primary outcome was the proportion of success at 12 months, defined as improvement in ≥1 qualifying LRF using weight (≥5% reduction), 6-min-walking distance (≥10% improvement), and urinary cotinine (200 ng/ml detection limit) without deterioration in the other 2.
Results The authors randomized 824 patients. Complete data on the primary outcome were available in 711 patients. The proportion of successful patients in the intervention group was 37% (133 of 360) compared with 26% (91 of 351) in the control group (p = 0.002; risk ratio: 1.43; 95% confidence interval: 1.14 to 1.78). In the intervention group, partner participation was associated with a significantly greater success rate (46% vs. 34%; p = 0.03).
Conclusions Among patients with coronary artery disease, nurse-coordinated referral to a comprehensive set of community-based, widely available lifestyle interventions, with optional partner participation, leads to significant improvements in LRFs. (RESPONSE-2: Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2; NTR3937)
- comprehensive lifestyle intervention
- coronary artery disease
- health behavior
- improvement of physical activity
- nurse-coordinated care
- secondary prevention
- smoking cessation
- weight reduction
The RESPONSE-2 trial was sponsored by Weight Watchers International, Inc. (New York, New York), Philips Consumer Lifestyle (the Netherlands), and an anonymous private fund (Amsterdam, the Netherlands). The sponsors had no role in the design, data collection, data analysis, data interpretation, and writing of the manuscript. Dr. Boekholdt has received personal fees from Pfizer. Dr. Peters has received personal fees from Sanofi, Boehringer Ingelheim, Amgen, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Minneboo and Lachman contributed equally to this work.
- Received March 14, 2017.
- Revision received May 15, 2017.
- Accepted May 16, 2017.
- 2017 American College of Cardiology Foundation
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