Program seen helpful in heart patients: report

A patient-centered program of telephone support, close monitoring and tight control of modifiable risk factors such as high blood pressure and cholesterol levels results in a significant improvement in "risk profiles" among survivors of heart attack and other acute heart "events," research shows.

The CHOICE program, which stands for Choice of Health Options In prevention of Cardiovascular Events, 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.

"CHOICE is an effective alternative for dealing with the widespread underuse of existing secondary prevention programs," the researchers conclude in the journal Heart.

Redfern and colleagues randomized study participants to the CHOICE program 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 factor modification and one office visit. All patients took action to lower their cholesterol levels, but could choose to participate in blood pressure reduction, smoking cessation or exercise activities.

At 1 year, average total cholesterol levels were lower in the CHOICE group compared with the control group. Blood pressure readings were also lower in the CHOICE program participants.

Furthermore, only 21 percent of CHOICE participants had three or more risk factors above recommended levels compared with 72 percent 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.

"We believe the success was 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," 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 forward and is the next step towards more widespread implementation. We are also following (these patients) for 4 years and will test whether 12 months of telephone follow-up is better than 3 months."

SOURCE: Heart, March 2009.