Colle B, Brusaferro S
Direzione Sanitaria A.S.S. n.3 Alto Friuli.
Ann Ig. 2008 May-Jun;20(3 Suppl 1):43-8.
The Euroaction project, promoted by European Society of Cardiology, aims to determine whether a nurse co-ordinated, multidisciplinary, family based preventive cardiology programme could help more patients and their families achieve the recommended European lifestyle, risk factor and therapeutic goals for cardiovascular disease prevention. EUROACTION was evaluated in a paired cluster randomized controlled trial, and the primary care branch included 6 European countries. Consecutive patients > 50 years and < 80 years, with no history of cardiovascular disease, were prospectively identified by the general practitioners with one of the following: (i) high total cardiovascular risk (HeartScore > or = 5% over 10 years, either now or when projected to age 60 years) and on no medical treatment for blood pressure, lipids or diabetes; (ii) on treatment with anti-hypertensive and/or lipid-lowering drug therapies started in the last year but with no diabetes; (iii) diagnosed with diabetes mellitus (treated by diet alone or with oral hypoglycaemic drug therapy and/or insulin) within the last three years in both intervention and usual care practices. All eligible high risk individuals and their partners were then invited by the nurse for an assessment of their lifestyle, risk factors and therapeutic management as soon as possible after identification. In the primary care intervention branch 1019 patients have been enrolled with no differences by sex and mean age 62, while in the control branch 1005 patients were recruited with mean age 63, female were 43%. The main results show that Intervention group (I) had a statistically significant improvement compared to Usual Care (UC) in the assumption of recommended quantity of fruit and vegetables (78.4% I vs 38.8% UC p=0.005), in the weight loss (weight loss > al 5% in subjects with BMI > 25 kg/m2) (16.5% I vs 6.8% UC p=0.005), in blood pressure control both in people specifically treated with drugs and untreated (respectively 52% I vs 35% UC p=0.04 and 65% Ivs 45% UC p=0.02), in reaching the European target for total cholesterol (Total Cholesterol < 5.0 mmol/l) during the study year (from 21.9% to 35.8% (I) absolute increase 12.7% (p=0.025) vs from 33% to 32.2% (UC)). No significant differences were found about change of smoking habits. The experimented intervention model based on a multidisciplinary approach and nurses leaded showed a good one year impact in reducing cardiovascular risk factors in high risk people. This model should be further tested in local contexts.
由欧洲心脏病学会推动的“欧洲行动”项目，旨在确定一项由护士协调的、多学科的、基于家庭的预防性心脏病学项目是否能帮助更多患者及其家人实现欧洲推荐的生活方式、危险因素及心血管疾病预防的治疗目标。“欧洲行动”在一项配对整群随机对照试验中进行了评估，初级保健分支涵盖6个欧洲国家。年龄在50岁以上且80岁以下、无心血管疾病史的连续患者，由全科医生通过以下情况之一进行前瞻性识别：（i）心血管总体风险高（10年内心脏风险评分≥5%，无论是现在还是预计到60岁时）且未接受过血压、血脂或糖尿病治疗；（ii）在过去一年开始接受抗高血压和/或降脂药物治疗但无糖尿病；（iii）在干预和常规护理实践中，过去三年内被诊断为糖尿病（仅通过饮食治疗或口服降糖药物治疗和/或胰岛素治疗）。所有符合条件的高危个体及其伴侣随后由护士邀请，在识别后尽快对其生活方式、危险因素和治疗管理进行评估。在初级保健干预分支中，已招募1019名患者，性别和平均年龄62岁无差异，而在对照分支中招募了1005名患者，平均年龄63岁，女性占43%。主要结果显示，与常规护理（UC）相比，干预组（I）在以下方面有统计学显著改善：摄入推荐量的水果和蔬菜（I组78.4% vs UC组38.8%，p = 0.005）、体重减轻（BMI＞25 kg/m²的受试者体重减轻＞5%）（I组16.5% vs UC组6.8%，p = 0.005）、接受药物治疗和未接受药物治疗的人群血压控制情况（分别为I组52% vs UC组35%，p = 0.04；I组65% vs UC组45%，p = 故02）、在研究年度达到欧洲总胆固醇目标（总胆固醇＜5.0 mmol/L）（从21.9%升至35.8%（I组），绝对增加12.7%（p = 0.025） vs 从33%降至32.2%（UC组））。在吸烟习惯改变方面未发现显著差异。基于多学科方法且由护士主导的实验性干预模式，在降低高危人群心血管危险因素方面显示出良好的一年期效果。该模式应在当地环境中进一步测试。
