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Effects of a nurse coordinated program of lifestyle interventions aimed at reducing the risk of recurrent events in patients who have suffered a heart attack.


- candidate number14680
- NTR NumberNTR3937
- ISRCTNISRCTN wordt niet meer aangevraagd.
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR8-apr-2013
- Secondary IDs2012_272 / NL41645.018.12; METC / CCMO
- Public TitleEffects of a nurse coordinated program of lifestyle interventions aimed at reducing the risk of recurrent events in patients who have suffered a heart attack.
- Scientific TitleEffects of a nurse coordinated program of lifestyle interventions aimed at reducing the risk of recurrent cardiovascular events in patients who have suffered an acute coronary syndrome: RESPONSE 2 Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2

RESPONSE 2:
Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2.
- ACRONYMRESPONSE 2
- hypothesisA comprehensive multisiciplinary lifestyle intervention program reduces the risk of recurrent cardiovascular events in patients who have suffered an acute coronary syndrome.
- Healt Condition(s) or Problem(s) studiedAcute coronary syndrome (ACS), Nurse coordinated care, Secundary prevention, Coronary artery disease
- Inclusion criteriaPatients aged 18-80 years who have been hospitalized for an acute coronary syndrome less than 4 weeks before inclusion and who have at least one of the following lifestyle related risk factors:
1. Smoking (including smoking of any tobacco product in the 6 months preceding hospitalisation);
2. BMI≥27 kg/m2;
3. Physical activity below recommended levels (self reported, 5 times 30 minutes/week)
- Exclusion criteriaPatients are ineligible if they meet any of the following exclusion criteria:
1. Visits to the prevention programs not feasible;
2. Not available for follow-up;
3. Coronary arterial bypass graft surgery expected within 8 weeks after inclusion;
4. Limited life expectancy (≤2 years);
5. New York Heart Association class III or IV heart failure;
6. Patients with a HADS (Hospital Anxiety Depression Scale) score ≥ 14 will also be excluded from randomisation, but they will be included in a separate registry and invited for follow-up measurements after 12 months.
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingNone
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-apr-2013
- planned closingdate1-aug-2016
- Target number of participants1000
- InterventionsOn top of usual care, the intervention group will receive a comprehensive, modular, tailored lifestyle intervention, involving the partner where appropriate, using e-health support and referral to up to three existing commercial programs for weight reduction (Weight Watchers®), physical exercise (DirectLife®, Philips) and smoking cessation (Luchtsignaal®). Each intervention program lasts at least 3 months. Weight Watchers and DirectLife can be offered for a longer period than 3 months if necessary. Weight Watchers offers a program aimed at reducing weight and at improving awareness of healthy foods. DirectLife offers a commercial activity program, to improve more awareness of the daily physical activity. This program consists of an accelerometer and a personal coach in a web based system. Luchtsignaal offers personal telephone based coaching during 3 months, including drug intervention where appropriate. The control group will receive care as usual; patients randomized in this group will not be offered a commercial program in order to improve their lifestyle. As per current guidelines, they will be advised by their nurse (practitioner) to improve their lifestyle. If necessary, patients may be referred to existing smoking cessation programs.
- Primary outcomeThe following parameters are compared between the intervention group and the control group at 12 months:
1. Smoking status (binary, non-smoking is defined as urinary cotinine < 200 ng/ml);
2. Body Mass Index (kg/m2);
3. 6 Minute walking distance (meters).

Treatment success in an individual patient is defined as a significant improvement in at least one of the suboptimal lifestyle factors, without deterioration in any of the other two.
- Secondary outcomeComparison between baseline and 12 months of:
1. Smoking status (urinary cotinine < 200 ng /ml);
2. Body Mass Index (kg/m2);
3. Waist circumference (cm);
4. 6 Minute walking distance (meters).
The following parameters are compared between the intervention group and the control group at 12 months:
1. Fasting serum LDL level (mmol /l);
2. Systolic blood pressure (mmHg);
3. Incidence of newly diagnosed diabetes mellitus;
4. Control of existing diabetes mellitus (fasting blood glucose and plasma HbA1c levels);
5. Body composition (fat and muscle mass by impedance scales);
6. Hospital readmission rates;
7. Signs of depression (Hospital Anxiety and Depression score).
- TimepointsAfter 12 months each patient will be invited for 12 month follow-up.

In this research there will be specific visits for measurements:

Five nurse led visits will be offered, including the baseline visit and the 12 months follow-up visit. During each visit the cardiovascular risk profile will be evaluated including of lifestyle related risk factors.

During a year patients in the intervention group have the opportunity to attend the offered commercial programs in order to improve their lifestyles, with their partner where appropriate.

Full study measurements will be performed at baseline and at 12 months follow-up.
- Trial web siteN/A
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIESMD, Research Fellow Sangeeta Lachman
- CONTACT for SCIENTIFIC QUERIESMD, PhD, R.J.G. Peters
- Sponsor/Initiator Academic Medical Center (AMC), Department of Cardiology
- Funding
(Source(s) of Monetary or Material Support)
Stichting Möller Foundation Amsterdam, Philips, Weight Watchers, Philips Consumer Lifestyle Nederland
- PublicationsN/A
- Brief summaryA previous trial, RESPONSE 1, demonstrated that a practice oriented, hospital-based nurse coordinated prevention program on top of usual care leads to an important reduction in the risk of recurrent events in patients who have been hospitalised for an acute coronary syndrome. This improvement was achieved by better control of targets for drug treatment, including blood pressure and serum lipids. Lifestyle improvements were not achieved, however particularly regarding smoking cessation, physical exercise or weight loss.
The RESPONSE 2 trial will focus on lifestyle improvements by offering existing commercial programs regarding the lifestyles mentioned above. The study design consists of a multicenter randomised controlled trial, in at least 10 participating centres in the Netherlands The primary outcome of RESPONSE 2 is the achievement of successful management of lifestyle related risk factors in the intervention group compared to the control group after 12 months follow-up.
- Main changes (audit trail)'Patients aged 18-80 years who have been ….. less than 8 weeks (instead of 4) before inclusion and who have at least one of the following lifestyle related risk factors'

Added the folowing sentence to interventions: Patients with a HADS > 14 will be included in a separate registry.They will not participate in the randomization and their results will not contribute to the primary outcome of the study.

Timepoints: Up to six, instead of five, nurse led visits will be offered, including the baseline visit and the 12 months follow-up visit.

The study design consists of a multicenter randomised controlled trial, in 1000 patients in approximately 10-15 participating centres in the Netherlands

10-jul-2014: Inclusion criterium changed into: "Patients aged 18years and older who have been hospitalized for an acute coronary syndrome or patients who have recently undergone coronary artery bypass surgery or a percutaneous coronary intervention less than 8 (instead of 4) weeks before inclusion and who have at least one of the following lifestyle related risk factors:"

Additional of secondary outcome:
8. Heart Rate Recovery after the 6 Minute Walk test - AB
- RECORD8-apr-2013 - 10-jul-2014


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