title: Preventing cardiovascular disease in primary care: role of a national risk factor management program.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Research Facility, National University of Ireland, Galway, Ireland.
authors.forename: Emer R
authors.initials: ER
authors.lastname: McGrath
authors.forename: Liam G
authors.initials: LG
authors.lastname: Glynn
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.forename: Aengus
authors.initials: A
authors.lastname: O Conghaile
authors.forename: Michelle
authors.initials: M
authors.lastname: Canavan
authors.forename: Claire
authors.initials: C
authors.lastname: Reid
authors.forename: Brian
authors.initials: B
authors.lastname: Moloney
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Donnell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019468:Disease Management; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D016016:Proportional Hazards Models; D012308:Risk Management; D055502:Secondary Prevention
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents