title: Interventions to maintain cardiac risk control after discharge from a cardiovascular risk reduction clinic: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the efficacy of two maintenance strategies compared to usual care after discharge from a pharmacist-led cardiovascular risk reduction clinic (CRRC).
  
  
  METHODS
  Open-label, randomized-controlled trial of 200 consecutive CRRC patients that met clinic discharge criteria (HbA1c ≤7% (53 mmol/mol); blood pressure ≤140/80 mmHg for those with diabetes and ≤140/90 mmHg for those without diabetes; and an LDL-cholesterol ≤2.59 mmol/l). Participants were randomized to either quarterly group medical visits or quarterly CRRC individual clinic visits, or a usual care control arm with the standard primary care alone first in a 1:1:1 ratio, followed by a 2:2:1 ratio after first 100 patients. Primary outcome measures were time to failure for guideline recommended goals of HbA1c and blood pressure over 12-months.
  
  
  RESULTS
  Of the 200 participants randomized, 89% had diabetes and were similar in other cardiovascular risk factors. After 1-year, the HbA1c failure rate was 0.36 [95% CI, 0.28-0.47] per quarter for the group medical visit arm, 0.24 [95% CI, 0.18-0.33] per quarter for the quarterly CRRC individual arm and, 0.82 [95% CI, 0.69-0.96] per quarter for the usual care control arm, p<0.001. The rate of failure for blood pressure was 0.31 [95% CI, 0.23-0.41] per quarter for the group medical visit arm, 0.22 [95% CI, 0.16-0.30] per quarter for the CRRC individual arm and, 0.53 [95% CI, 0.40-0.71] per quarter the control arm, p<0.001.
  
  
  CONCLUSIONS
  After discharge from a CRRC program, both individual and group interventions are more effective in maintaining glycemia and blood pressure control for patients with diabetes than usual care after 1-year of follow-up.
authors: Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
authors: Tracey H
authors: TH
authors: Taveira
authors: Providence VA Medical Center, Providence, RI, United States; University of Rhode Island, Kingston, RI, United States; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States. Electronic address: Wen-Chih.Wu@va.gov.
authors: Wen-Chih
authors: WC
authors: Wu
mesh_terms: D000359:Aftercare; D000368:Aged; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D058065:Diabetic Cardiomyopathies / Q000097:blood / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods*; D040242:Risk Reduction Behavior
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Blood pressure; Diabetes; Hemoglobin A1c; Randomized controlled trial