Dorien Brouwer

100 Chapter 2.1 PART 2 multifactorial educational and behavioral programme or usual care. [80] Comprehensive cardiac rehabilitation sessions with one-to-one support were held monthly from month 1 to month 6, then every six-months for three years. Each session consisted of 30 min of supervised aerobic exercise, plus lifestyle and risk factor counselling lasting at least 1 h and reinforcement of preventive interventions lasting approximately 30 min. In this way, every patient received in total 15 h of counselling in three-years. To improve adherence to lifestyle modification and help patients adopt a positive role in the care of their own health, a booklet explaining how to deal with exercise, diet, smoking cessation and stress management was distributed. The mutual support of family members was encouraged in ad hoc meetings together with the patients to make correct lifestyle habits more likely to be maintained in the long run. Compared with the usual care, the intensive intervention did not decrease the primary combined end point of fatal and nonfatal vascular events significantly, but intervention decreased several secondary end points like cardiovascular mortality plus nonfatal MI and stroke and induced a considerable improvement in lifestyle habits. In the EUROACTION study [81] , a cluster-randomized, controlled trial in eight European countries, a nurse-coordinated multidisciplinary, family-based preventive cardiology programme vs. standard care was investigated. More than 3000 patients with CAD and their partners were encouraged to achieve a healthy lifestyle with support from their families, other people attending the programme, and the health professionals – i.e., hospital nurses, dietitians and physiotherapists – who used stages of change and motivational interviews. Nurses coordinated a programme of eight workshops – one a week – for coronary heart disease; cardiovascular risks – i.e. lifestyle and risk factor control; cardioprotective treatments; and return to work and leisure. After completion of the 16- week hospital programme, patients and their partners were reassessed for lifestyle, risk factors and therapeutic management, and results were sent to each individual’s own family doctor. All patients and their partners were invited back for reassessment at one-year. Endpoints were smoking cessation, blood pressure <140/90mmHg, LDL <3 mmol/l, BMI <25 kg/m2, physical activity ≥30 min more than four times per week, intake of more than 400 g a day of fruits and vegetables and < 10% of total energy supplied by saturated fat. This study did not include vascular events as endpoints. The intervention group had significantly lower blood pressures, made significantly healthier food choices and became physically more active. This effect was mainly attributed to lifestyle change supported by families.