title: Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice.
abstract: OBJECTIVE
  To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease.
  
  
  METHODS
  A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction).
  
  
  METHODS
  48 general practices in the Republic of Ireland and Northern Ireland.
  
  
  METHODS
  903 patients with established coronary heart disease at baseline in the original trial.
  
  
  METHODS
  The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased.
  
  
  METHODS
  
  
  
  METHODS
  hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control.
  
  
  RESULTS
  At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol.
  
  
  CONCLUSIONS
  Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN24081411.
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: A W
authors.initials: AW
authors.lastname: Murphy
authors.affiliation: UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: M E
authors.initials: ME
authors.lastname: Cupples
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Murphy
authors.affiliation: Health Research Board Clinical Research Facility, National University of Ireland, Galway, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Newell
authors.affiliation: School of Mathematic and Statistics, University of Canterbury, Christchurch, New Zealand.
authors.forename: C J
authors.initials: CJ
authors.lastname: Scarrott
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Vellinga
authors.affiliation: School of Business and Economics, National University of Ireland, Galway, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Gillespie
authors.affiliation: School of Psychology, National University of Ireland, Galway, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Kearney
authors.affiliation: Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
mesh_terms: D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D005500:Follow-Up Studies; D058006:General Practice; D006760:Hospitalization; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000517:prevention & control; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D007494:Ireland; D009660:Northern Ireland; D017063:Outcome Assessment, Health Care; D055502:Secondary Prevention