Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2011;64:13-20 - Vol. 64 Num.01 DOI: 10.1016/j.rec.2010.06.007

Randomized Clinical Trial to Assess the Efficacy of a Comprehensive Programme of Secondary Prevention of Cardiovascular Disease in General Practice: The PREseAP Study

Carlos Brotons a,, Núria Soriano a, Irene Moral a, María P. Rodrigo b, Pilar Kloppe c, Ana I. Rodríguez d, María L. González e, Dolores Ariño f, Domingo Orozco g, Francisco Buitrago h, Josep M. Pepió i, Isabel Borrás j

a Unidad de Investigación, Equipo de Atención Primaria Sardenya-IIB Sant Pau, Barcelona, Spain
b Centro de Salud Plaza del Ejército,Valladolid, Spain
c Centro de Salud Las Calesas, Madrid, Spain
d Centro de Salud Las Arenas, Las Arenas-Getxo, Bilbao, Spain
e Centro de Salud San Agustín, Burgos, Spain
f Centro de Salud San Pablo, Zaragoza, Spain
g Unidad de Investigación, Hospital Clínico San Juan, Alicante, Spain
h Centro de Salud La Paz, Badajoz, Spain
i Equipo de Atención Primaria Tortosa Oest, Tarragona, Spain
j Centro de Salud Manacor, Manacor, Palma de Mallorca, Spain

Refers to

Keywords

Secondary prevention. Cardiovascular disease. General Practice.

Abstract

Introduction and objectives

To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice.

Methods

A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischaemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centres throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up.

Results

In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5%–34.8%) in the intervention group and 25.6% (22.3%–29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3%–11.3%) in the intervention group and 11% (7.4%–16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44cm (95% CI, 98.97–101.91cm) and 102.58cm (95% CI, 100.96–104.21cm), respectively (P=.07). Overall, 20.9% (15.6%–27.7%) of patients in the intervention group and 29.6% (23.9%–36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4%–37.9%) in the intervention group and 41.4% (35.8%–47.3%) in the control group had depression (P=.02).

Conclusions

A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced.

1885-5857/© 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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