title: Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Ischaemic heart disease (IHD) is the most common cause of death worldwide.
  
  
  OBJECTIVE
  To determine the long-term impact of organisational interventions for secondary prevention of IHD.
  
  
  METHODS
  Systematic review and meta-analysis of studies from CENTRAL, MEDLINE(®), Embase, and CINAHL published January 2007 to January 2013.
  
  
  METHODS
  Searches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random-effects model was used and risk ratios were calculated.
  
  
  RESULTS
  Five studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7-6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval [CI] = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7-6 years.
  
  
  CONCLUSIONS
  Cardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4-6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely.
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Edel
authors.initials: E
authors.lastname: Murphy
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Akke
authors.initials: A
authors.lastname: Vellinga
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Molly
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Department of General Practice and UKCRC Centre for Excellence for Public Health Research (NI), Queen's University, Belfast, UK.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cupples
authors.affiliation: Discipline of General Practice, School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.affiliation: Department of Surgery, University of the Philippines Manila, Manila, the Philippines, and clinical research associate, Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: Brian
authors.initials: B
authors.lastname: Buckley
authors.affiliation: Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
mesh_terms: D002423:Cause of Death / Q000639:trends; D014943:Global Health; D006760:Hospitalization / Q000639:trends; D006801:Humans; D017202:Myocardial Ischemia / Q000401:mortality / Q000517:prevention & control*; D011320:Primary Health Care / Q000458:organization & administration*; D018570:Risk Assessment / Q000458:organization & administration*; D055502:Secondary Prevention / Q000458:organization & administration*; D015996:Survival Rate / Q000639:trends
keywords: cardiovascular disease; coronary artery disease; general practice; systematic review