title: Randomized Trial of a Pharmacist-Delivered Intervention for Improving Lipid-Lowering Medication Adherence among Patients with Coronary Heart Disease Four-year follow-up of the Choice of Health Options In prevention of Cardiovascular Events randomized controlled trial Improving psychologic adjustment to chronic illness in cardiac patients Randomized controlled trial of a telephone intervention by nurses to provide information and support to patients and their partners after elective coronary artery bypass graft surgery: effects of anxiety. Differences in sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation Enhancing Postoperative Recovery of Cardiac Surgery Patients Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome? Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the "real world"--randomized controlled trial. A supportive-educative telephone program: impact on knowledge and anxiety after coronary artery bypass graft surgery. Patient‐Centered Modular Secondary Prevention Following Acute Coronary Syndrome: A RANDOMIZED CONTROLLED TRIAL Impact of medical consultation frequency on modifiable risk factors and medications at 12 months after acute coronary syndrome in the CHOICE randomised controlled trial. Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. Outcomes of cardiac rehabilitation with versus without a follow-up intervention rendered by telephone (Luebeck follow-up trial): overall and gender-specific effects The Effect of a Telephone Counseling Intervention on Self-Rated Health of Cardiac Patients Interactive voice response telephony to promote smoking cessation in patients with heart disease: a pilot study. Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial
abstract: A r and omized trial of a pharmacist-delivered intervention ( PI ) versus usual care ( UC ) was conducted ; 689 subjects with known coronary heart disease were recruited from cardiac catheterization laboratories . Participants in the PI condition received 5 pharmacist-delivered telephone counseling calls post-hospital discharge . At one year , 65 % in the PI condition and 60 % in the UC condition achieved an LDL-C level < 100 mg/dL ( P = .29 ) ; mean statin adherence was 0.88 in the PI , and 0.90 in the UC ( P = .51 ) . The highest percentage of those who reached the LDL-C goal were participants who used statins as opposed to those who did not use statins ( 67 % versus 58 % , P = .05 ) . However , only 53 % and 56 % of the patients in the UC and PI conditions , respectively , were using statins . We conclude that a pharmacist-delivered intervention aim ed only at improving patient adherence is unlikely to positively affect outcomes . Efforts must be oriented towards influencing physicians to increase statin prescription rates Objective : To determine if the improved risk factor profile at 1 year attributed to the Choice of Health Options In prevention of Cardiovascular Events ( CHOICE ) program was maintained at 4 years . Design : Single-blind r and omized controlled trial with post-hoc 47 ± 6 months follow-up ( 76 % complete ) . Setting : Australian tertiary referral hospital . Patients : Two hundred and eight acute coronary syndrome survivors . Interventions : Acute coronary syndrome survivors not accessing cardiac rehabilitation ( CR )  were r and omized to control ( n = 72 ) or CHOICE ( n = 72 ) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support . A contemporary CR reference group were also recruited ( n = 64 ) . Blinded risk assessment occurred at baseline , 1 and 4 years . Main outcome measures : Total cholesterol , systolic blood pressure , smoking status , physical activity . Results : One year improvements in all the modifiable risk factors achieved in CHOICE were maintained at 4 years . CHOICE and control were well-matched at baseline . At 4 years , there was a trend towards lower total cholesterol in CHOICE compared with controls ( mean 4.0 ± 0.1 vs. 4.2 ± 0.1 mmol/l , P = 0.05 ) , significantly better systolic blood pressure ( mean 132.2 ± 2.1 vs. 136.8 ± 2.0 mmHg , P = 0.01 ) , physical activity scores ( 1200 ± 209 vs. 968 ± 196 metabolic equivalent min/week , P = 0.02 ) and proportion with three or more risk factors above national targets ( 20 vs. 42 % , P = 0.02 ) . Participants in CHOICE were at higher baseline risk than CR but at 4 years they had similar risk factor profiles . Conclusion : Participants in CHOICE maintained favorable changes in coronary risk profile at 4 years compared with control , indicating that CHOICE is an effective long-term intervention among those not accessing facility-based CR Abstract BACKGROUND : Poor mood adjustment to chronic medical illness is often accompanied by decrements in function . OBJECTIVE : To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness . DESIGN : R and omized , controlled trial . METHODS : We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale ( HADS ) with scores indicative of mood disturbances at 1-month postdischarge . Recruited patients were r and omized to experimental or control status . Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns . Control patients received usual care . Patients ’ responses to the HADS and the Workplace Social Adjustment Scale ( WSAS ) were collected at baseline , 2 , 3 , and 6 months using interactive voice recognition technology . At baseline , the PRIME-MD was used to establish diagnosis of depression . We used mixed effects regression to study changes in outcomes . RESULTS : We enrolled 100 patients . Mean age was 60 ; 67 % of the patients were male . Findings confirmed that the intervention group had a 27 % improvement in depression symptoms ( P=.05 ) , 27 % in anxiety ( P=.02 ) , and a 38 % improvement in home limitations ( P=.04 ) compared with controls . Symptom improvement tracked those for WSAS measures of home function ( P=.04 ) but not workplace function . CONCLUSIONS : The intervention had a moderate effect on patient ’s emotional and functional outcomes that were observed during a critical period in patients ’ lives . Patient convenience , ease of delivery , and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness OBJECTIVE The purpose of this study was to determine the effectiveness of an information and support telephone intervention for reducing anxiety in patients who have undergone coronary artery bypass graft surgery and their partners . DESIGN The study is a r and omized controlled trial . Intervention began at discharge ; 6 telephone calls were made to patients and partners over 7 weeks . Primary outcome was Beck Anxiety Inventory measured at baseline in hospital , at home on day 3 , week 4 , and week 8 . SAMPLE The subjects were 131 patients who have undergone elective coronary artery bypass graft surgery and their partners . RESULTS Patients ' anxiety was moderate to severe the day before discharge . It was significantly lower in the treatment group than in the control group at day 2 at home . Partners always had lower anxiety than patients . A more sustained decrease in anxiety in the partner treatment group was found at both day 2 and week 4 . CONCLUSION Intervention effect is in the early period after discharge-- the time most affected by reduced lengths of stay Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients ’ during the first 5 weeks following hospital discharge . Patients ( N = 200 ) were r and omly allocated to two groups : ( a ) an intervention group who received telephone calls from an advanced practice nurse ( APN ) familiar with their clinical condition and care needs , twice during the first week following discharge then weekly thereafter for 4 weeks , and ( b ) a usual care group . Measures of health-related quality of life ( HRQL ) , symptom distress , satisfaction with recovery care , and unexpected health care contacts were obtained at 5 weeks following discharge . There were no significant group differences in HRQL , unexpected contacts with the health care system , or symptom distress . The provision of APN support via telephone followup after cardiac surgery is feasible . However , further r and omized trials of single and multicomponent APN interventions are needed to prove effectiveness Background Providing information is an important part of st and ard care and treatment for acute myocardial infa rct ion in patients . Evidence exists indicating that acute myocardial infa rct ion patients experience an information gap in the period immediately after discharge from the hospital . The aim of this study was to assess the short-term effects of a nurse-led telephone follow-up intervention to provide information and support to patients with acute myocardial infa rct ion after their discharge from hospital . Design and method A prospect i ve r and omized , controlled trial with a 6-month follow-up was conducted . A total of 288 patients were allocated to either an intervention group ( n = 156 ) or a control group ( n = 132 ) . The latter received routine post-discharge care . The primary endpoint measured at 3 and 6 months after discharge was the health-related quality of life using the 36-item Short Form Health Survey . Secondary endpoints included smoking and exercise habits . Results In both groups , health-related quality of life improved significantly over time on most subscales . A statistically significant difference in favour of the intervention group was found on the 36-item Short Form Health Survey Physical Health Component Summary Scale ( P=0.034 ) after 6 months . No difference was found between the groups on the Mental Health Component Summary Scale . We found a significant difference with respect to frequency of physical activity in favour of the intervention group after 6 months ( P=0.004 ) . More participants in the intervention group than the control group had ceased smoking at the 6-month follow-up ( P=0.055 ) . Conclusion A nurse-led systematic telephone follow-up intervention significantly improved the physical dimension of health-related quality of life in patients in the intervention group compared with usual care patients . Participation in this intervention also seemed to promote health behaviour change in patients after acute myocardial infa rct ion OBJECTIVE The purpose of this study was to test the effect of a post-discharge telephone counseling intervention on women 's psychosocial adjustment following a cardiac event . DESIGN The study was a prospect i ve , r and omized , controlled trial . PATIENTS Women ( n = 196 ) were recruited from 4 hospitals in Sydney , Australia , who were hospitalized for coronary artery disease : myocardial infa rct ion , coronary artery bypass grafts , coronary angioplasty , or stable angina . Women were r and omized to usual care ( n = 103 ) or telephone counseling ( n = 93 ) and were 67 years of age ( range 34 - 92 ) . The majority had not completed high school ( 92 % ) and were not employed ( 84 % ) . OUTCOMES Psychosocial adjustment was measured by the Psychosocial Adjustment to Illness Scale and the Hospital Anxiety and Depression Scale the day before hospital discharge and 12 weeks postdischarge . INTERVENTION Individualized information and support , was design ed to promote self-managed recovery and psychosocial adjustment , and began with an evaluation during admission and was followed up by telephone counseling at 1 , 2 , 3 , and 6 weeks after discharge . RESULTS The intervention had no effect on psychosocial adjustment ( F[1,182 ] = 0.06 , P = .8 ) , anxiety ( F[1,182 ] = 0.15 , P = .69 ) or depression ( F[1,182 ] = 0.11 , P = .74 ) at 12 weeks after discharge . Women made significant improvements during the 12 weeks on mean scores for psychosocial adjustment ( F[1,182 ] = 58.37 , P = .00 ) , anxiety ( F [ 1,182 ] = 74.58 , P = .00 ) and depression ( F[1,182 ] = 14.11 , P = .00 ) . The predictors of poor psychosocial outcomes for women included being less than 55 years of age , being unemployed or retired , having poor psychosocial adjustment to illness at baseline , having readmission , or experiencing a stressful , personal event during follow-up . CONCLUSIONS Women at risk for poor outcomes following hospitalization for a cardiac event can be identified ( ie , women less than 55 years of age , unemployed or retired , poorly adjusted to their cardiac illness , or readmitted to hospital within 12 weeks of a previous cardiac admission ) , but an effective intervention to enhance psychosocial outcomes remains to be established BACKGROUND Disease management programs in which drugs are prescribed by dietitians or nurses have been shown to improve the coronary risk factor profile in patients with coronary heart disease . However , those disease management programs in which drugs are not prescribed by allied health professionals have not improved coronary risk factor status . The objective of the Coaching patients On Achieving Cardiovascular Health ( COACH ) study was to determine whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol ( TC ) and other risk factors . METHODS Multicenter r and omized controlled trial in which 792 patients from 6 university teaching hospitals underwent a stratified r and omization by cardiac diagnosis within each hospital : 398 were assigned to usual care plus The COACH Program and 394 to usual care alone .  Patients in The  COACH Program group  received regular personal coaching via telephone and mailings to achieve the target levels for their particular coronary risk factors . There was one coach per hospital . The primary outcome was the change in TC ( DeltaTC ) from baseline ( in hospital ) to 6 months after r and omization . Secondary outcomes included measurement of a wide range of physical , nutritional , and psychological factors . The analysis was performed by intention to treat . RESULTS The COACH Program achieved a significantly greater DeltaTC than usual care alone : the mean DeltaTC was 21 mg/dL ( 0.54 mmol/L ) ( 95 % confidence interval [ CI ] , 16 - 25 mg/dL [ 0.42 - 0.65 mmol/L ] ) in The COACH Program vs 7 mg/dL ( 0.18 mmol/L ) ( 95 % CI , 3 - 11 mg/dL [ 0.07 - 0.29 mmol/L ] ) in the usual care group ( P<.0001 ) . Thus , the reduction in TC from baseline to 6 months after r and omization was 14 mg/dL ( 0.36 mmol/L ) ( 95 % CI , 8 - 20 mg/dL [ 0.20 - 0.52 mmol/L ] ) greater in The COACH Program group than in the usual care group . Coaching produced substantial improvements in most of the other coronary risk factors and in patient quality of life . CONCLUSIONS Coaching , delivered as The COACH Program , is a highly effective strategy in reducing TC and many other coronary risk factors in patients with coronary heart disease .  Coaching has potential effectiveness in the whole area of chronic disease management Objective To compare the long-term effectiveness of hospital versus telephone-monitored home-based exercise training during  cardiac rehabilitation ( CR ) on exercise capacity and habitual physical activity . Design Six-year follow-up of patients who participated in a r and omised controlled trial of hospital versus monitored home-based exercise training during CR after coronary artery bypass graft surgery . Setting Outpatient CR centre in Central -South Ontario , Canada . Participants 196 Patients who participated in the original r and omised controlled trial and who attended an evaluation 1 year after CR . Interventions 6 months of home or hospital-based exercise training during CR . Main outcome measures Peak oxygen uptake ( peak Vo2 ) , Physical Activity Scale in the Elderly ( PASE ) to assess habitual activity , semi-structured interviews to assess vital status , demographic and descriptive information . Results Of the 196 eligible patients , 144 ( 75.5 % ; 74 Hospital , 70 Home ) were available for participation . Patients were predominantly male ( n=120 ; 83.3 % ) aged 70±9.5 years .  Clinical and sociodemographic outcomes were similar in both groups . While exercise performance declined over time , there were significant between-group differences in peak Vo2 ( 1506±418 ml/min vs 1393±341 ml/min ; p=0.017 ) and PASE scores ( 166.7±90.2 vs 139.7±66.5 ; p=0.001 ) at 6-year follow-up in favour of the home group . Conclusions Home and hospital-based exercise training maintained exercise capacity above pre-CR levels 6 years after CR . Exercise training initiated in the home environment in low-risk patients undergoing coronary artery bypass graft surgery conferred greater long-term benefit on Vo2 and persistent physical activity compared with traditional hospital-based CR Background Telephone counseling in chronic disease self-management is increasing , but has not been tested in studies that control for quality of medical care . Objective To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention ( behaviors , medication ) in patients with acute coronary syndrome ( ACS ) following discharge from hospital , and impact on physical functioning and quality of life at 8 months post-discharge . Design Patient-level r and omized trial of hospital quality improvement ( QI-only ) versus quality improvement plus brief telephone coaching in three months post-hospitalization ( QI-plus ) . Data : medical record , state vital records , patient surveys ( baseline , three and eight months post-hospitalization ) . Analysis : pooled-time series generalized estimating equations to analyze repeated measures ; intention-to-treat analysis . Participants Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled ; 525 completed baseline surveys . Measurements We measured secondary prevention behaviors , physical functioning , and quality of life . Results QI-plus patients showed higher self-reported physical activity ( OR = 1.53 ; p = .01 ) during the first three months , with decline after active intervention was withdrawn . Smoking cessation and medication use were not different at 3 or 8 months ; functional status and quality of life were not different at 8 months . Conclusions Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term , but not long-term life-style behavior change . Previous positive results shown in primary care did not transfer to free-st and ing telephone counseling as an adjunct to care following hospitalization Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease ( CHD ) . An effective strategy is required for the application of evidence -based prevention therapy for CHD . The objective of this study was to test coaching as a technique to assist patients in achieving the target cholesterol level of < 4.5 mmol/L. Patients with established CHD ( n = 245 ) underwent a stratified r and omization by cardiac procedure ( coronary artery bypass graft surgery or percutaneous coronary intervention ) to receive either the coaching intervention ( n = 121 ) or usual medical care ( n = 124 ) . The primary outcome measure was fasting serum total cholesterol ( TC ) , serum triglyceride ( TG ) , high-density lipoprotein cholesterol ( HDL-C ) , and calculated low-density lipoprotein cholesterol ( LDL-C ) level , measured at 6 months post-r and omization . At 6 months , the serum TC and LDL-C levels were significantly lower in the coaching intervention group ( n = 107 ) than the usual care group ( n = 112 ) : mean TC ( 95%CI ) 5.00 ( 4.82 - 5.17 ) mmol/L versus 5.54 ( 5.36 - 5.72 ) mmol/L ( P < .0001 ) ; mean LDL-C ( 95%CI ) 3.11 ( 2.94 - 3.29 ) mmol/L versus 3.57 ( 3.39 - 3.75 ) mmol/L ( P < .0004 ) , respectively . Coaching had no impact on TG or on HDL-C levels . Multivariate analysis showed that being coached ( P < .001 ) had an effect of equal magnitude to being prescribed lipid-lowering drug therapy ( P < .001 ) . The effectiveness of the coaching intervention is best explained by both adherence to drug therapy and to dietary advice given . Coaching may be an appropriate method to reduce the treatment gap in applying evidence -based medicine to the " real world . The purpose of this study was to investigate the impact of a supportive-educative telephone program on the levels of knowledge and anxiety of patients undergoing coronary artery bypass graft surgery during the first 6 weeks after hospital discharge . With a posttest-only control group design , the first 74 patients scheduled , between September 1986 and February 1987 , for coronary artery bypass graft surgery in a large , western Canadian teaching hospital were r and omly assigned to either an experimental or a control group . The effect of the intervention , which was implemented by a cardiac rehabilitation nurse specialist , was assessed by a knowledge test and a state anxiety inventory . Data were collected without knowledge of the participants ' group assignment . As hypothesized , data analysis with independent t tests revealed a statistically significant ( p less than 0.05 ) difference between the knowledge level of the experimental and the control group in the areas of coronary artery disease , diet , medications , physical activity restrictions , exercise , and rest . A statistically significant difference between the state anxiety level of the experimental and the control group was also evident , as was a statistically significant inverse relationship between participants ' knowledge and anxiety levels . From these findings , several implication s and recommendations for nursing practice and research have been generated PURPOSE Cardiac rehabilitation ( CR ) is beneficial for those who attend , but alternative models for nonattenders need investigation . We tested the effectiveness of modular prevention on risk factors in survivors of acute coronary syndrome ( ACS ) not accessing CR . METHODS We r and omly allocated ACS survivors not accessing CR to a control group ( n = 72 ) receiving conventional care or modular group ( n = 72 ) who participated in risk factor modules on the basis of patient-centered care and collaborative goal setting to systematic ally lower risk factors . We also recruited a consecutive reference group of ACS survivors participating in CR ( n = 64 ) . Blinded measurements of risk factors and global risk were completed at baseline and 3 months . RESULTS Although well matched for risk factor level and prevalence at baseline , by 3 months , the modular group had significantly reduced risk factor level in comparison with controls for most risk factors including total cholesterol ( 158 ± 3.9 vs 186 ± 3.9 mg/dL , P < .001 ) , systolic blood pressure ( 133.5 ± 2.0 vs 144.4 ± 2.4 mm Hg , P < .01 ) , body mass index ( 28.9 ± 0.7 vs 31.0 ± 0.7 kg/m2 , P = .02 ) , and physical activity ( 1,187 ± 164 vs 636 ± 115 metabolic equivalents [METS]/kg/min , P < .01 ) . Also at 3 months , fewer patients in the modular group smoked than in the control group ( 6 % vs 23 % , P < .01 ) and were in the moderate to high-risk category of the Long-Term Intervention  with Pravastatin in Ischemic Disease ( LIPID ) score ( 40 % vs 59 % , P = .02 ) . Although the modular group had higher risk factors at baseline , they achieved similar mean levels as the CR group at 3 months . CONCLUSIONS Patient-centered modular prevention significantly improves coronary risk profile in comparison with conventional care and provides an effective alternative for the large numbers of ACS survivors not accessing CR BACKGROUND We aim ed to determine whether the frequency of General Practitioner and Cardiologist consultations impacted on improvements in risk factors in Choice of Health Options in Reducing Cardiovascular Events ( CHOICE ) r and omised controlled trial . METHODS Retrospective subgroup analysis of single-blind r and omised controlled trial . We included acute coronary syndrome survivors not accessing cardiac rehabilitation in the CHOICE trial whose General Practitioner or Cardiologist returned a visit frequency survey . The CHOICE group participated in tailored risk factor reduction packaged as clinic visit plus 3 months telephone support . Controls participated in physician-directed usual medical care . We compared total cholesterol , systolic blood pressure , smoking status , physical activity , number of modifiable risk factors and medications with frequency of medical consultations at baseline and 12 months . RESULTS Most control and CHOICE patients saw their General Practitioner≥5 times ( 85 % vs 90 % ) and Cardiologist at least once ( 65 % vs 57 % ) . CHOICE patients had a significantly better modifiable risk profile ( factor levels and multiples ) and more patients were on evidence -based medications at 12 months compared to controls . In CHOICE , the significant reduction in total cholesterol was unrelated to medical visits but lower systolic blood pressure was significant in patients who saw their General Practitioner≥5 compared with ≤4 times . In controls , frequency of medical visits was not associated with any changes in risk profile . CONCLUSIONS Acute coronary syndrome survivors receiving frequent medical follow-up without packaged secondary prevention had no improvement in multiple risk factors over 12 months . CHOICE patients who saw their doctors frequently were more likely to have significantly reduced systolic blood pressure and be on evidence -based medications AIMS An earlier combined proactive and reactive telephone follow-up intervention for acute myocardial infa rct ion patients after discharge from hospital showed positive effects after six months . The aim of the present study was to assess whether the intervention has long-term effects up to 18 months after discharge . DESIGN A prospect i ve r and omised controlled trial with 18 months follow-up . METHOD The trial was conducted with 288 patients allocated to a telephone follow-up intervention group ( n = 156 ) or control group ( n = 132 ) . The primary endpoint was health-related quality of life using the SF-36 . Secondary endpoints included smoking and exercise habits , return to work and rehospitalisation due to chest pain . RESULTS There were significant improvements over time on most dimensions of health-related quality of life in both the intervention and control group to US norm population levels on most SF-36 dimensions and summary scores . The intervention group showed no overall significant improvement beyond six months in the physical or mental summary scores , but there was a significant effect for those aged 70 or above . Although there was a promising effect for rehospitalisation due to chest pain , no significant differences were found between the groups on the secondary endpoints after six months . CONCLUSION This study demonstrated that despite positive short-term effects at six months , the telephone follow-up intervention had no long-term effects on health-related quality of life or secondary endpoints . However , the potential for improvement beyond six months was less than anticipated reflecting a reduced morbidity among acute myocardial infa rct ion patients . RELEVANCE TO CLINICAL PRACTICE Telephone follow-up after discharge from hospital is an easy implementable follow-up intervention enabling individualised provision of information and support in a time often experienced as stressful by patients . Our study indicates that six months is an adequate support period . Despite positive results six months after discharge no significant added long-term effects of telephone follow-up , compared to usual care were found in this study A health education and counselling programme was offered to myocardial infa rct ion patients during and after hospitalization . A r and omized pre-test-post-test control group design was used to evaluate the effects of the experimental intervention . During hospitalization the intervention consisted of two individual counselling sessions and two group health education sessions focusing on medication , healthy habits , anxiety and depression . On completion of these sessions , weekly telephone calls were made to patients for a period of six weeks after discharge from hospital . The intervention was offered to 30 myocardial infa rct ion patients and their partners ( the experimental group ) in addition to  st and ard medical care . Thirty control patients received st and ard medical care only . Two months after myocardial infa rct ion , patients in the experimental condition reported a significantly greater increase in physical activity , and a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , anxiety and depression . Twelve months after discharge from hospital patients in the experimental condition reported a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , physical activity , anxiety and depression . In addition , two months after myocardial infa rct ion , it was found that patients whose partners participated in the health education sessions showed a significantly greater decrease in smoking and unhealthy eating habits and a significantly greater increase in physical activity than patients with no partner participating . Twelve months after discharge the only significant result favouring the patients whose partner participated in the health education sessions concerned smoking cessation The effects of a nurse-managed secondary prevention program for patients after acute cardiac events were examined . Special interest was given to gender-specific results . The design was a prospect i ve , r and omized , controlled trial involving 343 patients following 3 weeks of inpatient cardiac rehabilitation , r and omly assigned to either of two study groups . Patients in the treatment group were contacted monthly by phone over 1 year . The main goals of the intervention were the reduction of behavioural coronary risk factors and enhancing quality of life . The program was conducted by specially trained nurses . The control group received written information only . Primary outcome was the Framingham risk score . Follow-up examination after 12 months was completed by 297 patients . Patients in the intervention group showed lower Framingham risk scores as compared to controls . Separate analyses by sex revealed that this was mostly due to the men in the sample . Women , on the other h and , showed a significant rise of clinical ly relevant anxiety/depressiveness in the control but not in the intervention group ; in males there were no differences between study conditions . In conclusion , telephone counselling by specially trained nurses seems a cost-effective way to achieve a lasting reduction in cardiac risk factors and to maintain the effects of cardiac rehabilitation . Effekte eines von Pflegepersonal durchgefuehrten Nachsorgeprogramms fuer Koronarpatienten wurden untersucht . Besondere Aufmerksamkeit galt moeglichen Gendereffekten . Es h and elt sich um eine prospektive , r and omisierte , kontrollierte Studie . 343 Patienten wurden nach stationaerer kardiologischer Rehabilitation auf eine von zwei Studiengruppen r and omisiert . Patienten in der Interventions gruppe wurden über ein Jahr ca . einmal i m Monat telephonisch kontaktiert . Hauptziele der Intervention waren die effektive und nachhaltige Reduktion verhaltensgebundener Risikofaktoren sowie die Verbesserung der Lebensqualitaet . Das Programm wurde von speziell dafuer fortgebildetem Pflegepersonal durchgefuehrt . Die Kontrollgruppe erhielt nur schriftliches Informations material . Primaerer Endpunkt war das globale koronare Risiko ( Framingham Score ) . Von 297 Patienten wurden komplette Date n bei der Abschlussuntersuchung nach 12 Monaten erhalten . Patienten in der Interventions gruppe zeigten niedrigere Framingham-Scores als Kontrollpatienten . Getrennte Analysen nach Geschlecht ergaben , dass dieser Effekt hauptsaechlich auf die Maenner zurueckzufuehren ist ; bei den Frauen zeigten sich keine Unterschiede zwischen den Studiengruppen . Auf der and eren Seite zeigte sich bei den Frauen in der Kontrollgruppe eine deutliche Zunahme an Angst bzw . Depressivitaet ; ein entsprechender Effekt f and sich bei den Maennern nicht . Telefonische Nachsorge durch speziell fortgebildetes Pflegepersonal scheint ein kostenguenstiger Weg zu sein , koronare Risikofaktoren zu reduzieren und die Effekte von kardiologischer Rehabilitation aufrechtzuerhalten . Se evaluaron los result ados de un programa secundario de prevención dirigido por el personal de enfermería para pacientes que han sufrido un trastorno cardiovascular agudo . Se dio una especial importancia a los result ados específicos para cada sexo . Se trata de un estudio prospect ivo , aleatorizado , comparativo , en el que participaron 343 pacientes tras 3 semanas de haber recibido rehabilitación cardiovascular , a quienes se dividieron en dos grupos , de manera aleatoria . Los pacientes del grupo que recibió tratamiento fueron contactados por teléfono una vez al mes durante 1 año . Los principales objetivos de la intervención fueron reducir los factores de riesgo de las cardiopatías arterioscleróticas relacionados con el actuar de los pacientes , y mejorar la calidad de vida de éstos . La realización del programa estuvo a cargo de un grupo de enfermeras y enfermeros especialmente entrenados para ello . El grupo de referencia recibió información sólo por escrito . Los result ados iniciales se obtuvieron aplic and o la escala de riesgo de Framingham . En las valoraciones de seguimiento , realizadas tras 12 meses , participaron 292 pacientes . Los valores en la escala de riesgo de Framingham fueron más bajos en los pacientes del grupo que recibió la intervención que en el grupo de referencia . Los análisis según el sexo revelaron que el aporte mayor a este result ado provino de los varones de la muestra . Por su parte , las mujeres del grupo de referencia presentaron un aumento importante de la ansiedad/depresión relacionada con el proceso de enfermedad , lo cual no se apreció en el grupo que recibió tratamiento . Entre los varones no se apreciaron diferencias relacionadas con las condiciones del estudio . En conclusión , el apoyo emocional por vía telefónica brindado por el personal de enfermería especialmente entrenado para ello parece ser una manera rentable de disminuir de forma perdurable los factores de riesgo para las cardiopatías arterioscleróticas , así como de perpetuar los result ados de la rehabilitación cardiovascular . Cette étude examine les effets d'un programme de prévention secondaire sous surveillance du personnel infirmier pour les patients ayant souffert d'incidents cardiaques aigus . Une attention toute particulière a été donnée aux résultats selon le sexe . L'essai était de type prospect if , r and omisé et contrôlé , avec la participation de 343 patients après 3 semaines de rééducation cardiaque dans des conditions d'hospitalisation , affectés de manière aléatoire à l'un ou l'autre des deux groupes d'étude . Les patients appartenant au groupe de traitement ont été contactés tous les mois par téléphone sur une période de 1 an . Les principaux objectifs de l'intervention étaient la réduction des facteurs comportementaux de risque coronaire et l'amélioration de la qualité de vie . Le programme était administré par des infirmiers spécialement formés . Le groupe témoin recevait simplement des informations écrites . Le principal résultat était le score de risque de Framingham .  297 patients ont subi des examens de suivi après 12 mois . Les patients appartenant au groupe d'intervention ont affiché des scores de risque de Framingham inférieurs à ceux du groupe témoin . Les analyses séparées par sexe révèlent que la différence porte principalement sur les hommes . Les femmes , par contre , affichent une augmentation significative des tendances dépressives/à l'anxiété , cliniquement pertinente dans le groupe témoin , contrairement au groupe d'intervention ; chez les hommes , on ne note aucune différence entre les conditions d'étude . En conclusion , le conseil téléphonique administré par des infirmiers spécialement formés semble constituer un mode économique et efficace pour parvenir à une réduction durable des facteurs de risques cardiaques et préserver les effets de la rééducation cardiaque Objective : The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness . Methods : We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale ( HADS ) indicating mild to severe depression and /or anxiety at 1 month postdischarge . Recruited patients were r and omized into either an intervention or control group . Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears . Control patients received  usual care . For both groups , we collected patients ’ responses to the HADS and to the Global Improvement ( CGI-I ) subscale of the Clinical Global Impressions ( CGI ) Scale at baseline and at 2 , 3 , and 6 months postbaseline using Interactive Voice Recognition ( IVR ) technologies . We used mixed-effects analysis to estimate patients ’ changes in CGI-I measures over the three time points of data collection postbaseline . Results : We enrolled 100 patients , and complete CGI-I measures were collected for 79 study patients . The mean age was 60 years ( st and ard deviation = 10 ) , and 67 % of the patients were male . A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health ( SRH ) between baseline and month 3 than the control group ( p = .01 ) . Between month 3 and month 6 , no significant differences in SRH improvements were observed between the control and intervention groups . Conclusions : Study patients reported greater SRH improvement result ing from the telephone-based intervention compared with control subjects . Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders . ACS = acute coronary syndrome ; ADL = activities of daily living ; CAD = coronary artery disease ; CGI = Clinical Global Impressions Scale ; CGI-I = Global Improvement subscale of the Clinical Global Impressions ( CGI ) Scale ; ENRICHD = Enhancing Recovery in Heart Disease Patients trial ; HADS = Hospital and Anxiety Depression Scale ; HTS = Healthcare Technology Systems ; ICD-9 = International Classification of Diseases , Ninth Edition ; IRB = Institutional Review Boards ; IVR = interactive voice recognition ; MI = myocardial infa rct ion ; SADHART = the Sertraline Antidepressant Heart Attack R and omized Trial ; SRH = self-rated health OBJECTIVE A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response ( IVR ) follow-up system for smokers recently hospitalized with coronary heart disease ( CHD ) . METHODS Ninety-nine smokers hospitalized with CHD completed a baseline question naire , were provided with bedside counseling , and offered nicotine replacement therapy . They were r and omly assigned to a usual care ( UC ) or an IVR group . The IVR group received automated telephone follow-up calls 3 , 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free . When deemed necessary , they were offered additional counseling .  Smoking status was determined 52 weeks after hospital discharge . RESULTS The 52-week point prevalence abstinence rate in the IVR group was 46.0 % compared to 34.7 % in the UC group ( OR=1.60 , 95 % CI : 0.71 - 3.60 ; P=.25 ) . After adjustment for education , age , reason for hospitalization , length of hospitalization , and quit attempts in the past year , the odds of quitting in the IVR group compared to the UC group were 2.34 ( 95 % CI : 0.92 - 5.92 ; P=.07 ) . CONCLUSIONS IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital , however , a larger trial is required to confirm its efficacy . PRACTICE IMPLICATION S IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD Objective : To determine the effect of a new CHOICE ( Choice of Health Options In prevention of Cardiovascular Events ) programme on cardiovascular risk factors in acute coronary syndrome ( ACS ) survivors . Design : Single-blind r and omised controlled trial . Setting : Tertiary referral hospital in Sydney Australia . Patients : 144 ACS survivors who were not accessing st and ard cardiac rehabilitation .  Data were also collected on a further 64 ACS survivors attending st and ard cardiac rehabilitation . Intervention : The CHOICE group ( n = 72 ) participated in a brief , patient-centred , modular programme comprising a clinic visit plus telephone support , encompassing m and atory cholesterol lowering and tailored preferential risk modification . The control group ( n = 72 ) participated in continuing conventional care but no central ly coordinated secondary prevention . Main outcome measures : Values for total cholesterol , systolic blood pressure , smoking status and physical activity . Results : CHOICE and control groups were well matched at baseline . At 12 months , the CHOICE group ( n = 67 ) had significantly better risk factor levels than controls ( n = 69 ) for total cholesterol ( TC ) ( mean ( SEM ) 4.0 ( 0.1 ) vs 4.7 ( 0.1 ) mmol/l , p<0.001 ) , systolic blood pressure ( 131.6 ( 1.8 ) vs 143.9 ( 2.3 ) mm Hg , p<0.001 ) , body mass index ( 28.9 ( 0.7 ) vs 31.2 ( 0.7 ) kg/m2 , p = 0.025 ) and physical activity ( 1369.1 ( 167.2 ) vs 715.1 ( 103.5 ) METS/kg/min , p = 0.001 ) as well as a better knowledge of risk factor targets . Also at 1 year , fewer CHOICE participants ( 21 % ) had three or more risk factors above widely recommended levels then controls ( 72 % ) ( p<0.001 ) . Conclusions : Participation in a brief CHOICE programme significantly improved the modifiable risk profiles and risk factor knowledge of ACS survivors over 12 months . CHOICE is an effective alternative for dealing with the widespread underuse of existing secondary prevention programmes . Trial registration number : IS RCT
target: Conclusions Compared to st and ard post-discharge care , regular telephone support interventions may help reduce feelings of anxiety and depression as well as , improve systolic blood pressure control and the likelihood of smoking cessation
background: Background Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness .
  However , patient participation remains suboptimal and the provision of high quality care to an exp and ing population of patients with chronic heart conditions is becoming increasingly difficult .
  A systematic review and meta- analysis was conducted to determine the effect of telephone support interventions compared with st and ard post-discharge care on coronary artery disease patient outcomes .