Intensified preventive care to reduce cardiovascular risk in healthcare centres located in deprived neighbourhoods: a randomized controlled trial

Background We examined the effectiveness of a structured collaboration in general practice between a practice nurse, a peer health educator, the general practitioner (GP) and a GP assistant in providing intensified preventive care for patients at high risk of developing cardiovascular diseases. Design A randomized controlled trial in three healthcare centres (18 G Ps) in deprived neighbourhoods of two major Dutch cities. Methods Two hundred seventy-five high-risk patients (30-70 years) from various ethnic groups were randomized to intervention (n = 137) or usual care group (n = 138). We determined group differences in outcomes [1 0-year absolute risk (Framingham risk equation), blood pressure, lipids and body mass index] at 12-month follow-up. Results The 10-year absolute risk was reduced by 1.76% (standard error: 0.81) in intervention and by 2.27% (standard error: 0.69) in usual care group; the difference in mean change was 0.88% [95% confidence interval: - 1.16 to 2.931. In both groups significant reductions were observed in the following individual risk factors: total cholesterol, total cholesterol/highdensity lipoprotein cholesterol, and low-density lipoprotein cholesterol, with no relevance between group differences. Conclusion The cardiovascular risk profile of intervention and control patients improved after 1 -year follow-up. However, no extra effect of the structured preventive care on the risk for cardiovascular diseases was achieved. Eur J Cardiovasc Prev Rehabil 15:488-493 (c) 2008 The European Society of Cardiology