NEW YORK (Reuters Health) – A patient-centered program of telephone support, close monitoring and tight control of modifiable risk factors such as blood pressure and cholesterol levels results in a significant improvement in risk profiles among survivors of acute coronary syndrome (ACS) events.

The CHOICE (Choice of Health Options in prevention of Cardiovascular Events) program was developed by Dr. Julie Redfern and colleagues at Concord Hospital in New South Wales, Australia. Their study involved 144 ACS survivors “who were not accessing standard cardiac rehabilitation.”

Patients were randomized to CHOICE or to a control group who received conventional follow-up care but no coordinated secondary prevention. The researchers also measured outcomes of 64 ACS survivors who participated in standard cardiac rehabilitation.

The CHOICE program consists of telephone support, patient-tailored risk modification and one clinic visit. All patients undertook cholesterol-lowering actions, but could choose to participate in blood pressure reduction, smoking cessation or exercise activities. Main outcome measures were total cholesterol, systolic blood pressure, smoking status and physical activity.

At 12 months, mean total cholesterol was 4.0 mmol/L in the CHOICE group compared with 4.7 mmol/L in controls. Other parameters in the two groups included systolic blood pressures of 131.6 vs 143.9 mm Hg, and body mass indexes of 28.9 vs 31.2, respectively.

Only 21% of CHOICE participants had three or more risk factors above recommended levels compared with 72% of controls. Patients in the CHOICE program also had a better knowledge of risk factor targets than controls, and their physical activity level was almost twice as high as in controls.

“CHOICE is an effective alternative for dealing with the widespread underuse of existing secondary prevention programs,” the researchers conclude in the March issue of Heart.

“We believe the success was to due to the patients having an active choice regarding how they would manage their risk factors, the individual attention the patients received, as well as the components of CHOICE,” Dr. Redfern told Reuters Health.

“We now have further research funding and are running an “implementation trial” at four hospitals in Sydney. This is a great step forwarded and is the next step towards more widespread implementation. We are also following [these patients] for four years and will test whether 12 months of telephone follow-up is better than 3 months.”

The study is accompanied by an editorial from Dr. Michael V. Jelinek of Fitzroy, Australia. The CHOICE study and others, he writes, have “refocused our attention on inactivity as a cause, and physical activity as an effective treatment, of CHD. This is a timely reminder that the prevention and treatment of CHD involves lifestyle as well as biomedical interventions.”

Reference:
Heart 2009;95:441,468-475.