护士协调的健康与生活方式干预对降低地区成年人多种心血管代谢风险因素的影响：MODERN随机对照试验的结果

Nurse co-ordinated health and lifestyle modification for reducing multiple cardio-metabolic risk factors in regional adults: outcomes from the MODERN randomized controlled trial.

作者信息

Carrington Melinda J, Zimmet Paul Z

机构信息

Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia.

Department of Diabetes, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia.

出版信息

Eur J Cardiovasc Nurs. 2022 Jan 11;21(1):26-35. doi: 10.1093/eurjcn/zvab042.

DOI:10.1093/eurjcn/zvab042

PMID:33899090

Abstract

BACKGROUND

Nurse-led health and lifestyle modification programmes can prevent cardio-metabolic diseases and be advantageous where health disparities exist.

AIMS

To assess the effectiveness of a nurse-driven health and lifestyle modification programme in improving cardio-metabolic risk parameters for higher-risk regional residing adults.

METHODS

We conducted an open, parallel-group randomized controlled trial in two sites. Participants were aged 40-70 years with no prior cardiovascular disease who had any three or more of; central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure (BP) and dysglycaemia. Intervention participants received individual face-to-face and telephone coaching for improving cardio-metabolic risk. Control group participants received standard care and general information about risk factor management. The primary endpoint was the percentage of participants who achieved the target risk factor thresholds or clinically significant minimum changes for any three or more cardio-metabolic risk factors during 24 months of follow-up.

RESULTS

Participant average age was 57.6 (SD 7.6) years, 61% were female and 71% were employed. The primary endpoint was achieved by 76% intervention (97 of 127) and 71% usual care (92 of 129) participants [adjusted risk ratio (RR): 1.08; 95% CI 0.94, 1.24; P = 0.298]. Improved BP in the intervention group was more likely than in the control group (84% vs. 65%) (adj. RR: 1.28; 95% CI 1.11, 1.48; P = 0.001) but no other cardio-metabolic component.

CONCLUSION

Nurse intervention to modify cardio-metabolic risk parameters had no enhanced effectiveness compared with usual care. However, participation was associated with improvements in cardio-metabolic abnormalities, with particular emphasis on BP.

TRIAL REGISTRATION

Registered with the Australian New Zealand Clinical Trial Registry (ACTRN12616000229471).

摘要

背景

由护士主导的健康与生活方式改善计划可预防心血管代谢疾病，在存在健康差异的地方具有优势。

目的

评估由护士推动的健康与生活方式改善计划对改善高危地区居住成年人心血管代谢风险参数的有效性。

方法

我们在两个地点进行了一项开放、平行组随机对照试验。参与者年龄在40 - 70岁之间，无心血管疾病史，有以下任意三项或更多情况：中心性肥胖、甘油三酯升高、高密度脂蛋白胆固醇降低、血压升高和血糖异常。干预组参与者接受一对一的面对面和电话指导以改善心血管代谢风险。对照组参与者接受标准护理和关于风险因素管理的一般信息。主要终点是在24个月随访期间，达到任何三项或更多心血管代谢风险因素的目标风险因素阈值或临床上显著最小变化的参与者百分比。

结果

参与者平均年龄为57.6（标准差7.6）岁，61%为女性，71%就业。干预组76%（127人中的97人）和常规护理组71%（129人中的92人）达到主要终点[调整风险比（RR）：1.08；95%置信区间0.94，1.24；P = 0.298]。干预组血压改善的可能性高于对照组（84%对65%）（调整RR：1.28；95%置信区间1.11，1.48；P = 0.001），但其他心血管代谢指标无差异。