Secondary prevention programs for coronary heart disease that contain less than 10 hours contact with health professionals and those provided by family doctors are just as effective in saving lives as more expensive, longer and more specialized hospital-based alternatives, according to cardiovascular researchers at the University of Alberta in Edmonton, Canada.
Dr. Alexander Clark, an associate professor in the U of A Faculty of Nursing and Alberta Heritage Investigator, is lead author on an article published in the European Journal of Cardiovascular Prevention and Rehabilitation.
The study presents the results of a systematic review of 46 randomized trials -- all the published trials of secondary prevention programs in the English language. The programs collectively improve life expectancy and reduce hospitalizations. However, those that have fewer than 10 hours of contact time, are based in family care settings and use non-specialist family doctors and nurses, show an equal mortality benefit to longer, specialist-led programs.
The findings have a great impact on health care policy and funding, Clark said. "As the shorter and more generalist programs are as effective at saving patients' lives, these offer an attractive and highly efficient alternative to longer, more costly, and often less accessible hospital programs. As most programs have poor access, contain more than 50 hours contact with professionals, and heart disease affects more people in the world than any other disease, the implications of these findings for patients and health care costs are major."
The authors are careful to point out that participants in the studies they analyzed tended to be less complicated and younger.
"While those with more complicated conditions remain best served by specialist support services, the findings indicate that patients who have less complex heart disease can get equal benefit from shorter programs provided by local health professionals in their communities," Clark said. "Enrolment in longer programs provided by specialists can then be better targeted to those with more complicated disease."
Coronary heart disease remains the single biggest cause of death in the world and affects more than 20 million North Americans. Health Canada estimates the total cost of cardiovascular diseases on the health sector of the Canadian economy is more than $18.4 billion (11.6 per cent of the total cost of all illnesses). In the United States, costs are estimated to exceed $111.8 billion US per annum.
The research was funded by the Agency for Healthcare Research and Quality, Center for Medicare and Medicaid Services, U.S. Department of Health and Human Services.
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