Transcript EUROACTION MAIN SESSION BARCELONA

EUROACTION: Changes in diet and
physical activity over one year in a family
based preventive cardiology programme
in hospital and general practice
Jennifer Jones on behalf of the
EUROACTION study group
Department of Cardiovascular Medicine,
Imperial College, London, UK
The Multidisciplinary
family based EUROACTION
Programme
• In hospitals for coronary
patients and their families
• In primary care for
individuals at high risk of
developing cardiovascular
disease and their partners
EUROACTION
Aim
To raise the standards of preventive cardiology in
Europe by demonstrating that the recommended
European and national lifestyle, risk factor and
therapeutic goals in cardiovascular disease
prevention are achievable and sustainable in
everyday clinical practice.
EUROACTION
Study design
A cluster randomised controlled trial in
hospital and general practice with clinical
follow-up at 16 weeks and 1 year
EUROACTION
8 countries 24 centres 10,000+ subjects
Generalisable model of
preventive cardiology care
Nurse-led multidisciplinary
approach
The EUROACTION team in Boldrini
Hospital, Thiene, Italy
The EUROACTION nurse and
the lead GP in Hoensbroek,
The Netherlands
Structure of the Programme in
Hospital and Primary Care
Identification and recruitment
•
•
•
•
•
•
Multi-disciplinary initial
assessment
Preventive Cardiology Programme
Empowering families to change their lifestyle: smoking,
diet and physical activity
Blood pressure, blood cholesterol and blood glucose
management
Compliance with cardio-protective medication
One to one and group approach
Supervised hospital and home exercise programme
Health promotion workshop programme
16 week assessment
(hospital only)
One year follow-up
Lifestyle change
• No smoking
• Saturated Fat: <10% total
Smoking cessation
Energy
• Fruits and vegetables:
>400g/day
• Fish: >20g/day
• Oily Fish: >3 times/week
• 30-45 minutes of physical
activity at 60–75% of the
Healthy eating,
average maximum heart rate
Increasing
Weight
on four-five days of the week
Physical activity
management
• Weight reduction ≥ 5%
• Waist <94 cm in men and <80
cm in women
Aim of the dietary
intervention

To help patients and families to adopt a diet
associated with lowest risk of atherosclerotic
disease

To help patients and families to achieve a healthy
weight and shape
Dietary Intervention

Individual Dietary Assessment of family habits

Anthropometric measures

Goal Setting

Education on Cardio-protective diet

Individualised and group advice

Regular monitoring and follow up
If weight loss identified
as priority
Measuring height and weight

European Recommendations
• BMI:
• <25kg/m2
• Waist:
• Women <80cm; Men <94cm
• Target weights set
• 5-10% weight loss
•
•
•
•
Behaviour strategies
Weekly weigh ins
Portion sizes
Food diaries
Physical Activity
 Individual Physical Activity Assessment
 7 day activity recall
 Pedometer
 Functional capacity
 Functional limitation
 Activity perceptions, barriers and motivators
 Goal Setting
 Education on Benefits of Physical Activity
The Supervised Exercise
Programme in Hospital




Non-equipment based weekly
supervised programme
Tailored physical activity advice
Monitored
Progressive
Thiene, Italy


Identification of local facilities
Philosophy of empowerment
Valencia, Spain
Physical Activity Advice in
Primary Care

 
 
 

Facilities
Specialist schemes
Experts
Activities available
Educational Materials
Goal setting and
tracking progress
with the Personal
Record Card
RESULTS
Index Event: Coronary Patients
AMI
35%
48%
High Risk Patients
32%
UA
SCORE
42%
SA
17%
26%
69.9 % Male
49.8 % Male
Mean age overall 62.5 years
Mean age overall 62.0 years
BP &
Lipids
Diabetes
Hospital Arm
Usual Care
Intervention
PATIENTS
PARTNERS
PATIENTS
Identification
1694
828
1718
Initial assessment
1061 (67%)*
646
307
Participation in
the
Programme
860 (82%)**
410
946 (89%)**
401
One year assessment
*Of those eligible
**Of those who attended initial assessment
994
PARTNERS
802
335
Primary Care Arm
Usual Care
Intervention
PATIENTS
PARTNERS
PATIENTS
PARTNERS
Identification
1257
805
1752
830
Initial assessment
1118 (89%)*
261
331
NA
Participation in
the
Programme
947 (85%)**
204
1019 (91%)**
225
1005
363
One year assessment
*Of those eligible
**Of those who attended initial assessment
Change in proportion of patients achieving
the European targets for a healthy diet from
initial assessment to 1 year
Coronary Patients
+15.8%
(2.2 to 29.3)*
+11.8%
(-2.1 to 25.6)
30
High Risk Patients
+11.4%
(0.6 to 22.1)*
25
20
5
30
25
25
24
20
15
10
+23.6%
(9.1 to 38.2)*
5
3
Fruits and
Fish > 20 g/day
vegetables >400
g/day
 Intervention
0
Oily fish > 3
times/week
 Usual Care
+2.2%
(-1.7 to 6.2)
20
10
10
0
27
15
14
9
+16.5%
(-0.1 to 33.1)
*p<0.05
4
4
Fish > 20 g/day
Fruits and
vegetables >400
g/day
6
4
Oily fish > 3
times/week
Change in proportion of patients participating in
moderate intensity activity ≥4 times/week
≥30minutes from initial assessment to 1 year
High Risk Patients
Coronary Patients
30
+ 28.1% (13.9 to + 42.3)*
30
25
20
15
25
20
27
10
5
0
-5
15
10
5
0.2
0
 Intervention
+ 32.9% (1.8 to 53.9)*
 Usual Care
-10
-15
*p<0.05
24
-10
Mean change in BMI in those ≥25kg/m² and
from initial assessment to 1 year**
Coronary Patients
High Risk Patients
-0.69 kg/m² (-1.03 to -0.34)*
0.5
0.4
0.3
0.2
0.1
0
-0.1
-0.2
-0.3
-0.4
-2.8 kg/m² (-13.1 to +7.5)
0.1
0.2
0.4
0.1
0
-0.1
-0.2
-0.3
-0.3
-0.4
-0.5
-0.5
-0.6
 Intervention
 Usual Care
*p<0.05
**random subsample in usual care
Mean change in waist circumference in men
≥94cm and women ≥80cm from initial
assessment to 1 year**
Coronary Patients
High Risk Patients
-0.8 cm (-3.7 to 2.1)
0
-0.2
-0.4
-0.6
-0.8
-0.8
-1
-1.2
-1.4
-1.5
-1.6
 Intervention
 Usual Care
-1.61 cm (-2.61 to -0.61)*
0
-0.2
-0.4
-0.6
-0.8
-1
-1.2
-1.4
-1.6
-1.8
*p<0.05
-0.21
-1.66
**random subsample in usual care
Distribution of Waist Circumference
at One year – All Patients
Hospital
General Practice
*OR 0.61 (0.39 to 0.97),
p=0.04
*OR 0.70 (0.53 to 0.93),
p=0.02
% 60
% 60
57
50
40
40
51
54
40
30
30
31
20
50
22
29
20
26
10
10
0
0
Ideal
Level 1
*Proportional odds model
Level 2
25
23
27
15
Ideal
Level 1
Level 2
Conclusions
The nurse-led multidisciplinary EUROACTION
family based programme achieved significantly
better lifestyle changes for coronary and high
risk patients in terms of a more healthy diet,
reduction in abdominal obesity and increased
physical activity compared to usual care.
Conclusions
EUROACTION has set
new standards of preventive cardiology care
for coronary and high risk patients and their families in
everyday clinical practice
EUROACTION
A European Society of Cardiology
demonstration project in preventive
cardiology
www.escardio.org/euroaction
solely sponsored by an unconditional educational grant
from Astra Zeneca