Service organisation for the secondary prevention of ischaemic heart disease in primary care

Brian S Buckley; Mary C Byrne; Susan M Smith

doi:10.1002/14651858.CD006772.pub2

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Figure 1

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.1 Blood pressure within study protocol target level at 12 months.

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Figure 2

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.2 Blood pressure within study protocol target level at end of study (per protocol).

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Figure 3

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.3 Mean systolic blood pressure at 18 months.

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Figure 4

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.4 Mean diastolic blood pressure at 18 months.

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Figure 5

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.5 Mean systolic blood pressure at end of study (per protocol).

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Figure 6

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.6 Mean diastolic blood pressure at end of study (per protocol).

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Figure 7

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.7 Total blood cholesterol within study protocol target level (5.2 mmol/l) at 12 months.

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Figure 8

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.8 Total blood cholesterol within study protocol target level at end of study.

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Figure 9

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.9 Total blood cholesterol at end of study (per protocol).

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Figure 10

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.10 Prescribed lipid‐lowering medication at 18 months.

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Figure 11

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.11 Prescribed lipid‐lowering medication at end of study.

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Figure 12

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.12 Prescribed beta blockers at end of study.

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Figure 13

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.13 Prescribed ACE inhibitors at end of study.

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Figure 14

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.14 Prescribed anti‐platelet medication at 18 months.

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Figure 15

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.15 Prescribed inti‐platelet medication at end of study.

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Figure 16

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.16 Exercising at or above study target level at end of study.

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Figure 17

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.17 Smoking cessation at end of study.

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Figure 18

Forest plot of comparison: 1 Service organisation versus normal care, outcome: 1.18 Body mass index at end of study.

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Analysis 1.1

Comparison 1 Service organisation versus normal care, Outcome 1 Blood pressure within study protocol target level at 12 months.

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Analysis 1.2

Comparison 1 Service organisation versus normal care, Outcome 2 Blood pressure within study protocol target level at end of study (per protocol).

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Analysis 1.3

Comparison 1 Service organisation versus normal care, Outcome 3 Mean systolic blood pressure at 18 months.

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Analysis 1.4

Comparison 1 Service organisation versus normal care, Outcome 4 Mean diastolic blood pressure at 18 months.

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Analysis 1.5

Comparison 1 Service organisation versus normal care, Outcome 5 Mean systolic blood pressure at end of study (per protocol).

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Analysis 1.6

Comparison 1 Service organisation versus normal care, Outcome 6 Mean diastolic blood pressure at end of study (per protocol).

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Analysis 1.7

Comparison 1 Service organisation versus normal care, Outcome 7 Total blood cholesterol within study protocol target level (5.2 mmol/l) at 12 months.

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Analysis 1.8

Comparison 1 Service organisation versus normal care, Outcome 8 Total blood cholesterol within study protocol target level at end of study.

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Analysis 1.9

Comparison 1 Service organisation versus normal care, Outcome 9 Total blood cholesterol at end of study (per protocol).

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Analysis 1.10

Comparison 1 Service organisation versus normal care, Outcome 10 Prescribed lipid‐lowering medication at 18 months.

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Analysis 1.11

Comparison 1 Service organisation versus normal care, Outcome 11 Prescribed lipid‐lowering medication at end of study.

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Analysis 1.12

Comparison 1 Service organisation versus normal care, Outcome 12 Prescribed beta blockers at end of study.

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Analysis 1.13

Comparison 1 Service organisation versus normal care, Outcome 13 Prescribed ACE inhibitors at end of study.

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Analysis 1.14

Comparison 1 Service organisation versus normal care, Outcome 14 Prescribed anti‐platelet medication at 18 months.

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Analysis 1.15

Comparison 1 Service organisation versus normal care, Outcome 15 Prescribed anti‐platelet medication at end of study.

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Analysis 1.16

Comparison 1 Service organisation versus normal care, Outcome 16 Exercising at or above study target level at end of study.

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Analysis 1.17

Comparison 1 Service organisation versus normal care, Outcome 17 Smoking cessation at end of study.

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Analysis 1.18

Comparison 1 Service organisation versus normal care, Outcome 18 Body mass index at end of study.

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Table 1. Table of included studies

Study	Setting	Study participant recruitment criteria	Number and sex of participants	Mean age of participants (SD unless stated otherwise)	Elements included in intervention (see key in footnotes)	Study length (months)
Bond 2007b	England	Previous AMI, CABG, PTCA, diagnosed angina	1,441 (68% male)	Control: 68.8 (9.1) Intervention: 68.7 (9.2)	1,2,3,4,8	12
Campbell 1998	Scotland	Previous AMI, diagnosed angina	1,343 (58% male)	Control: 66.3 (8.2) Intervention: 66.1 (8.2)	1,2,3,4,7	12
Cupples 1994a	Northern Ireland	Previous AMI, diagnosed angina	688 (59% male)	Control: 63.6 (6.8) Intervention: 62.7 (7.1)	2,3,7	24
Eccles 2002	England	Diagnosed angina	2,881 Men & women	18+	4,6	12
Feder 1999	England	Previous AMI, diagnosed angina	328 (59% male)	Control: 64.8 Intervention: 66.4	3,4	12
Gao 2007	China	Previous CABG	368 (68% male)	Total: 62 (±11)	1,2,3,5	12
SHIP 1999	England	Previous AMI, diagnosed angina	597 (71% male)	Control: 64 (10) Intervention: 63 (10)	2,4,5,7	12
Kiessling 2002	Sweden	Previous AMI, CABG, PTCA, diagnosed angina	88 (85% male)	Control: 62.3 (7.4) Intervention: 62.6 (6.1)	4	24
Moher 2001a (GP led)	England	Previous AMI, CABG, PTCA, diagnosed angina	1,241 (67% male)	Control: 66.1 (5.4) Intervention: 66.4 (5.6)	2,4	18
Moher 2001b (nurse led)	England	Previous AMI, CABG, PTCA, diagnosed angina	1,224 (69% male)	Control: 66.1 (5.4) Intervention: 65.8 (5.8)	2,4,7	18
Munoz 2007	Spain	Previous AMI, diagnosed angina	983 (75% male)	Control: 63.6 (10.3) Intervention:64.2 (9.8)	1,2,3,4	36
SPHERE	Republic of Ireland and Northern Ireland	Previous AMI, CABG, PTCA, diagnosed angina	892 (70% male)	Control: 66.5 (9.9) Intervention: 68.5 (9.3)	1,2,3,4,7	18
Elements of interventions: Structured monitoring and assessment of risk factors and medications Preplanned appointment/s / patient recall Patient education or awareness raising regarding secondary prevention: risk factors, medications and lifestyle Clinician education or awareness raising regarding secondary prevention: promotion of clinical guidelines, clinical management advice, education or training Improved secondary/primary care interface Information technology based decision supports Nurse proactive in care management Pharmacist proactive in care management

Table 1. Table of included studies

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Comparison 1. Service organisation versus normal care

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Blood pressure within study protocol target level at 12 months Show forest plot	3	3126	Odds Ratio (M‐H, Random, 95% CI)	1.77 [1.00, 3.16]

2 Blood pressure within study protocol target level at end of study (per protocol) Show forest plot	4	3614	Odds Ratio (M‐H, Random, 95% CI)	1.50 [0.96, 2.35]

3 Mean systolic blood pressure at 18 months Show forest plot	3	646	Mean Difference (IV, Random, 95% CI)	3.11 [0.04, 6.19]

4 Mean diastolic blood pressure at 18 months Show forest plot	3	691	Mean Difference (IV, Random, 95% CI)	1.00 [‐0.66, 2.66]

5 Mean systolic blood pressure at end of study (per protocol) Show forest plot	5	1722	Mean Difference (IV, Random, 95% CI)	1.55 [‐0.35, 3.46]

6 Mean diastolic blood pressure at end of study (per protocol) Show forest plot	5	1767	Mean Difference (IV, Random, 95% CI)	0.70 [‐0.35, 1.76]

7 Total blood cholesterol within study protocol target level (5.2 mmol/l) at 12 months Show forest plot	2	1685	Odds Ratio (M‐H, Random, 95% CI)	1.90 [1.04, 3.48]

8 Total blood cholesterol within study protocol target level at end of study Show forest plot	3	2173	Odds Ratio (M‐H, Random, 95% CI)	1.37 [0.63, 3.01]

9 Total blood cholesterol at end of study (per protocol) Show forest plot	4	1410	Mean Difference (IV, Random, 95% CI)	0.06 [‐0.05, 0.17]

10 Prescribed lipid‐lowering medication at 18 months Show forest plot	3	776	Odds Ratio (M‐H, Random, 95% CI)	1.10 [0.76, 1.61]

11 Prescribed lipid‐lowering medication at end of study Show forest plot	6	2138	Odds Ratio (M‐H, Random, 95% CI)	0.97 [0.79, 1.19]

12 Prescribed beta blockers at end of study Show forest plot	3	1650	Odds Ratio (M‐H, Random, 95% CI)	0.86 [0.67, 1.10]

13 Prescribed ACE inhibitors at end of study Show forest plot	2	655	Odds Ratio (M‐H, Random, 95% CI)	0.86 [0.63, 1.18]

14 Prescribed anti‐platelet medication at 18 months Show forest plot	3	844	Odds Ratio (M‐H, Random, 95% CI)	0.98 [0.60, 1.58]

15 Prescribed anti‐platelet medication at end of study Show forest plot	6	5347	Odds Ratio (M‐H, Random, 95% CI)	1.16 [0.86, 1.57]

16 Exercising at or above study target level at end of study Show forest plot	3	3112	Odds Ratio (M‐H, Random, 95% CI)	1.11 [0.95, 1.29]

17 Smoking cessation at end of study Show forest plot	3	3272	Odds Ratio (M‐H, Random, 95% CI)	1.06 [0.89, 1.25]

18 Body mass index at end of study Show forest plot	3	1414	Mean Difference (IV, Random, 95% CI)	0.25 [‐0.28, 0.78]

Comparison 1. Service organisation versus normal care

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