EUROACTION set to change the face of preventive cardiology

Largest demonstration project in preventive cardiology improves heart health across Europe with emphasis on nurse-led team and family support - News Release

ISSUED BY EUROACTION

For immediate use
Sunday 3 September 2006

Final results from EUROACTION show that a nurse-led multi-disciplinary team approach, coupled with the support and involvement of a patient's partner and family, can yield significant lifestyle improvements and risk factor reductions in coronary patients and patients at risk of developing cardiovascular disease.

The largest ever European-wide preventive cardiology project, EUROACTION spanned eight countries and 24 hospital and general practice centres, in a cluster randomized controlled trial. The project addressed the cardiovascular health of over 10,000 coronary and high risk patients and their partners, according to the European preventive cardiology guidelines2. The inclusion of partners and family members underpinned EUROACTION's emphasis on family support and a shared commitment to heart-healthy living.

Professor David Wood, Professor of Cardiovascular Medicine at Imperial College London and Chairperson of EUROACTION comments: "With current treatment failing too many cardiovascular patients across Europe, EUROACTION has stepped up to the professional challenge of translating scientific evidence into effective care. Prevention guidelines are very difficult to implement, but the EUROACTION approach sets a new standard for preventive care across Europe which all hospitals and general practices can achieve."

Significant improvements were observed not only in EUROACTION patients but also in their partners, compared to usual care in other hospitals and general practices, across the key lifestyle and risk factors: diet (fruit and vegetable, saturated fat and oily fish intake), physical activity, central obesity, blood pressure, cholesterol and glucose. The administration of cardio-protective medication - anti-platelet therapy, beta-blockers, ACE inhibitors and statins - was also improved.

Results

Through the EUROACTION programme, three-quarters of patients (72% coronary and 78% high risk) and their partners (72% coronary and 77% high risk partners) achieved the recommended fruit and vegetable consumption (of ≥ 400g/day, equivalent to five standard portions), compared to just over a third of usual care patients (35% coronary and 39% high risk) and coronary partners (37%) and just over half the high risk patients' partners (54%). EUROACTION coronary patients also reduced their consumption of saturated fat (to <10% total energy achieved by 55% coronary EUROACTION patients versus 40% usual care) and twice as many met the recommended weekly intake of oily fish (≥ 3x/week achieved by 17% versus 8% in usual care), with similar trends seen in high risk patients and both partner groups.

Of the coronary patients and partners who were smokers at the time of the patient's cardiovascular event, over half the patients (58%) and nearly a quarter (23%) of their partners, stopped smoking and remained non-smokers at one year, an improvement on those in usual care (47% coronary patients and 18% partners).

Physical activity targets (of 30-45 minutes of exercise, four to five times per week, at 60-75% of average maximum heart rate), were achieved by twice as many EUROACTION patients as compared to usual care (54% coronary and 50% high risk EUROACTION patients, versus 20% and 22% respectively for usual care). EUROACTION partners again reflected this trend, with almost half as many achieving the exercise target as their peers in usual care (41% coronary and 44% high risk partners, versus 27% and 25% respectively in usual care).

In turn, central obesity (a waist circumference of ≥ 94 cms in men or ≥ 80 cms in women) was reduced across EUROACTION patients as compared to usual care (35% coronary and 27% high risk EUROACTION patients achieved an ideal waist circumference, compared to 22% and 21% respectively in usual care).

Blood pressure targets, according to European levels (<140/90 mmHg, or <130/85 mmHg for patients with diabetes) were consistently better achieved by patients on the EUROACTION programme, both for patients with and patients without diabetes. Almost three quarters (72%) of non-diabetic coronary and over two thirds (66%) of non-diabetic high risk patients met the targets, consistently higher than the usual care results in each case (60% for coronary and 48% for high risk). Diabetic patients reached their blood pressure target more successfully in the EUROACTION arm, with twice as many (38%) coronary diabetic patients reaching target than in usual care (17%), and the same for high risk EUROACTION diabetic patients; 38% at target compared to 19% in usual care

Cholesterol targets (Total cholesterol of <5 mmol/l) were achieved by the majority of both EUROACTION coronary (78%) and usual care coronary (71%) patients, and high risk EUROACTION patients demonstrated a significant increase in target achievement (from 23% to 36%) across the year, whilst the proportion of usual care high risk patients on target remained unchanged during the programme.

The recommended glycated haemoglobin target in diabetes was achieved by more EUROACTION patients (HbA1c of <7%) as compared to usual care (coronary patients 61% versus 50% for usual care; high-risk patients 80% versus 65% for usual care) reflecting better long term diabetic control.

Cardio-protective therapies, such as anti-platelets, beta-blockers, diuretics, ACE inhibitors and statins, were all found to be used more frequently in EUROACTION than in usual care patients, both in hospital and general practice, although to a lesser extent in the latter. These improvements in prescribing were achieved with lower cost generically available drugs from local formularies.

Professor David Wood, Chairperson of EUROACTION comments, "The principles of nurse-led multi-disciplinary teams, family- based lifestyle intervention as well as total cardiovascular risk management are all central features of EUROACTION which has demonstrated the potential to significantly improve the quality of patient care. Moreover, having run our prevention programme in busy hospitals and general practice settings, these results are directly applicable to everyday clinical practice."

Professor Michal Tendera, President of the ESC, says, "The European Society of Cardiology produces guidelines which set standards for best practice and measure the uptake of these through European-wide surveys. Now, for the first time, our society has demonstrated, through the EUROACTION project, that we can achieve these targets in a large majority of patients and to great effect. It is now up to us to follow the EUROACTION example and work to establish similar prevention programmes in every general hospital and general practice so that patients across Europe can receive the best possible care".

EUROACTION is an initiative of the European Society of Cardiology which further highlights its continued commitment to improve the quality of life of the European population by reducing the impact of cardiovascular disease, and was solely sponsored by AstraZeneca through the provision of an unconditional educational grant.

Ends

For further information about any aspect of the EUROACTION project, please contact:

Camilla Dormer / Fiona McMillan
Cohn & Wolfe
Office tel: +44 (0) 207 331 2335 / 5333
Onsite mobile: +44 (0) 7725 328 983 / +44 77 11 764 356
Email: camilla_dormer@uk.cohnwolfe.com

The EUROACTION project web pages are available at: www.escardio.org/EUROACTION 

Notes to editors

About EUROACTION

• EUROACTION was designed to demonstrate that a nurse-led multi-disciplinary team can help patients and families achieve the recommended lifestyle and ri sk factor reduction targets for cardiovascular disease (CVD) prevention.1
• It is the largest ever demonstration project in preventive cardiology in Europe, involving 10,792 patients and their families. EUROACTION is a cluster randomised controlled trial conducted in eight European countries:
  • Denmark
  • France
  • Italy
  • Poland
  • Spain
  • Sweden
  • The Netherlands
  • The United Kingdom

• EUROACTION embraces the complete spectrum of preventive cardiology: patients with newly diagnosed with coronary heart disease in hospital, patients at high risk of developing CVD in primary care and their family members, which sets it apart from other studies in preventive cardiology.
• EUROACTION was organized as a cluster randomised controlled trial in which 6 comparable pairs of busy general hospitals, and 6 comparable pairs of busy general practices were selected and randomised to receive the EUROACTION programme or simply be monitored for their usual care.
• Once recruited by the EUROACTION nurses, patients and their partners had a complete lifestyle and risk factor assessment and were then supported to make lifestyle changes with regular one-to-one and group workshops with members of the nurse-led multi-disciplinary (nurses, dietitians, physiotherapists, cardiologists and general practitioners) teams during the year.
• EUROACTION was conducted across Europe in busy general hospitals and family doctor practices. It is unique in having evaluated the impact of nurse-led multidisciplinary preventive cardiology programmes. EUROACTION is an important step towards the provision of comprehensive nurse led preventive cardiology programmes across Europe.
• For further full details on the study design and full one-year results, please refer to the EUROACTION Results Digest.

About the Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice

• The Task Force is constituted by representatives of the following eight societies and also by individual invited experts:
  • European Association for the Study of Diabetes (EASD)
  • International Diabetes Federation Europe (IDF-Europe)
  • European Atherosclerosis Society (EAS)
  • European Heart Network (EHN)
  • European Society of Cardiology (ESC)
  • European Society of Hypertension (ESH)
  • International Society of Behavioural Medicine (ISBM)
  • European Society of General Practice / Family Medicine (ESGP/FM).

• The Task Force published recommendations on prevention of CHD in 1994 and these were updated in 1998 (the patient priorities, lifestyle, risk factor and therapeutic targets from these recommendations were used in the EUROACTION study designed in 2002), and most recently in 20032 addressing cardiovascular disease as a whole.
• The priorities of the Guidelines are firstly, patients with established cardiovascular disease; secondly, high risk individuals and thirdly, the families of both coronary patients and high-risk individuals.
• The aim of the recommendations is to improve the practice of preventive cardiology by encouraging the development of national guidance on cardiovascular disease prevention and its communication, implementation and evaluation through national societies in each country.

About CVD and its Prevention

• Cardiovascular diseases (CVD), of which CHD is the most common, are the major cause of death worldwide.3
• CHD remains the leading cause of death in men aged over 45 years old, and in women over 65 years old.
• The burden of CHD remains high due to the ageing of populations and increased life expectancy of coronary patients due to more effective treatments for acute coronary heart disease and use of prophylactic drug therapies.
• The main objectives of CVD prevention are to increase the duration and improve the quality of a patients' life and to improve survival rates.