ESC/WCC: Intensive Life-Style Intervention Targets Patients and Families

BARCELONA, Spain, Sept. 6 -- An aggressive 16-week lifestyle intervention reduced cardiovascular risk factors in both patients and their domestic partners, according to a European trial.

But the approach might not be practical in the U.S., despite the impressive results, noted Raymond Gibbons, M.D., a Mayo Clinic cardiologist and president of the American Heart Association.

The guideline-focused program was led by nurse managers and other non-M.D. staffers, reported David Wood, M.D., of Imperial College London at University of London, at the Europeans Society of Cardiology/World Congress of Cardiology meeting here.

The 10,972-patient EuroAction study recruited patients with confirmed coronary artery disease as well as high-risk patients and the domestic partners of both.

Patients and partners were assigned to either a hospital-based intervention coordinated by nurses, with the help of dietitians and exercise counselors, or to primary care practice-based intervention managed by a single nurse educator.

In either case, the intervention lasted 16 weeks and involved both group and individual counseling sessions for patients and partners. The study endpoints were a series of guideline based goals such total smoking cessation, dietary fat intake of no more than 10% of total calories, increased exercise, reduced waist circumference and increased intake of fruits and vegetables.

Outcomes were compared to a cohort of similar patients and partners who received usual care.

Among the findings:

• The smoking endpoint of total cessation was not met. But, 58% of the hospitalized coronary patients in the active intervention and 23% of their partners stopped smoking versus a 47% smoking-cessation rate for usual care patients and 18% of their partners (P=0.06).
• Fifty-five percent of the patients in the hospitalized group reduced dietary saturated fat to less than 10% of total calories versus 40% of the patients in the usual-care hospitalized arm (P=0.009).
• More than 70% of the patients in the hospital-intervention arm and 72% of their partners were able to increase their consumption of fruits to 400 grams at day compared with 35% of the patients in the usual-care group (P=0.004).
• Seventeen percent of intervention patients and partners were eating oily fish three or more time as week versus 8% of usual-care patients (not significant).
• Thirty-five percent of hospital-based intervention patients and 27% of general practice intervention patients achieved ideal waist circumference (37 inches or less for men and 31 inches or less for women) versus 20% of hospital usual-care patients and 22% of general practice usual care patients (not significant).
• Seventy-two percent of the non-diabetic hospital-based patients and 66% of non-diabetic general practice patients achieved target blood pressure of less than 140/90 mm Hg versus 60% of hospital usual care and 48% of general practice usual care patients (not significant).
• Diabetic patients in the intervention arms were about twice as likely to reach target blood pressure (less than 130/80 mm Hg) than usual care patients (not significant).
• The recommended HbA1c of less than 7% was achieved by 71% compared with 50% for usual care; high-risk patients achieved 80% compared with 65% for usual care.

Dr. Wood said the EuroAction program was run in busy hospitals and general practices in eight countries, which "make these results directly applicable to every day clinical practice."

That may be an overstatement, commented Dr. Gibbons, the AHA, president.

Dr. Gibbons praised the EuroAction results and said he liked the idea of focusing an intervention on both the patient and the patient's partner, but he said it may not be practical in the United States.

Noting that insurers-including Medicare-often resist paying for preventive services, Dr. Gibbons added that "it is very unlikely that insurers would extend coverage for these services to partners."

Moreover, the intervention is labor intensive and Dr. Wood did not supply a cost effectiveness estimate. A high price tag could also derail efforts to establish a similar program in the U.S., Dr. Gibbons said.

The EuroAction participating countries were Denmark, France, Italy, Poland, Spain, Sweden, The Netherlands and the United Kingdom.

The EuroAction study was funded by AstraZeneca.