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.
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.


METHODS
Single-blind randomised controlled trial.


METHODS
Tertiary referral hospital in Sydney Australia.


METHODS
144 ACS survivors who were not accessing standard cardiac rehabilitation. Data were also collected on a further 64 ACS survivors attending standard cardiac rehabilitation.


METHODS
The CHOICE group (n = 72) participated in a brief, patient-centred, modular programme comprising a clinic visit plus telephone support, encompassing mandatory cholesterol lowering and tailored preferential risk modification. The control group (n = 72) participated in continuing conventional care but no centrally coordinated secondary prevention.


METHODS
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/m(2), 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.


BACKGROUND
ISRCTN42984084.
Redfern
J
J
Department of Cardiology, Concord Hospital, Hospital Road, Concord, Australia. julieredfern@dodo.com.au
Briffa
T
T
Ellis
E
E
Freedman
S B
SB
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D000368:Aged; D001794:Blood Pressure; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002755:Choice Behavior; D002784:Cholesterol / Q000097:blood; D004363:Drug Utilization / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010358:Patient Participation / Q000379:methods*; D011788:Quality of Life; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D002784:Cholesterol