Abstract

BACKGROUND
Heartwatch, a structured risk factor modification program for secondary prevention of cardiovascular (CV) disease (CVD) in primary care, is associated with improvements in CV risk factors in participating patients. However, it is not known whether Heartwatch translates into reductions in clinically important CV events.
OBJECTIVE
The aim of the study was to determine the association between participation in Heartwatch and future risk of CV events in patients with CVD.
METHODS
The study consisted of a prospective cohort of 1,609 patients with CVD in primary care practices. Of these, 97.5% had data available on Heartwatch participation status, of whom 15.2% were Heartwatch participants. Cox proportional hazards models were used to determine the association between Heartwatch participation and risk of the CV composite (CV death, nonfatal myocardial infarction, heart failure, and nonfatal stroke). All-cause mortality and CV mortality were secondary outcome measures.
RESULTS
During follow-up, the CV composite occurred in 208 patients (13.6%). Of Heartwatch participants, 8.4% experienced the CV composite compared with 14.5% of nonparticipants (P = .003). Participation in Heartwatch was associated with a significantly reduced risk of the CV composite (hazard ratio [HR] 0.52, 95% CI, 0.31-0.87), CV mortality (HR 0.31, 95% CI, 0.11-0.89), and all-cause mortality (HR 0.32, 95% CI, 0.15-0.68). Heartwatch participation was also associated with greater reductions in mean systolic blood pressure (P = .047), mean diastolic blood pressure (P < .001), and greater use of secondary preventative therapies for CVD, such as lipid-lowering agents (P < .001), β-blockers (P < .001), and angiotensin-converting enzyme inhibitors (P < .001).
CONCLUSION
Heartwatch is associated with a reduced risk of major vascular events and improved risk factor modification, supporting its potential as a nationwide program for secondary prevention of CVD.

Links

Publisher Full Text

Authors

McGrath ER, Glynn LG, Murphy AW, Conghaile AO, Canavan M, Reid C, Moloney B, O'Donnell MJ

Institution

Clinical Research Facility, National University of Ireland, Galway, Ireland.

Source

American heart journal 163:4 2012 Apr pg 714-9

MeSH

Adrenergic beta-Antagonists
Aged
Angiotensin-Converting Enzyme Inhibitors
Cardiovascular Diseases
Disease Management
Female
Humans
Hypolipidemic Agents
Male
Middle Aged
Primary Health Care
Proportional Hazards Models
Risk Management
Secondary Prevention

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22520539