The EUROACTION Trial

A comprehensive approach to cardiovascular prevention

• Collaboration across disciplines – nurses, dieticians, physiotherapists, cardiologists and general practitioners - reduces cardiovascular risk
• Family involvement increases patient commitment to lifestyle changes and treatment
• Preventive cardiology programmes are required for all coronary and high risk patients but must be adapted to local medical, cultural and economic settings

The single largest research project ever to be undertaken by the European Society of Cardiology1 (ESC), EUROACTION, showed that a multidisciplinary, family based and nurse coordinated programme made a real difference in improving lifestyle and reducing cardiovascular risk among coronary patients and people with a high risk2 of developing Cardiovascular Disease (CVD). EUROACTION implicated six pairs of hospitals and six pairs of general practices in eight European countries3. The trial involved over 10 000 coronary and high risk patients and lasted 3 years.

“EUROACTION is a landmark study showing that preventive goals can be achieved and are sustainable in everyday clinical practice” explains Prof Kim Fox, President of the ESC. “This study provides practical support to initiatives such as the European Heart Health Charter, promoted by the ESC together with the European Commission and the European Heart Network, in order to raise awareness of CVD prevention goals throughout Europe. It also demonstrates the European Society of Cardiology’s commitment to prevention”.

The ESC regularly updates its European Guidelines on CVD Prevention4, the latest version was published in 2007.

Previous studies conducted by the ESC –Euroaspire I, II and III5- showed that CVD prevention in routine clinical practice was inadequate, with only a third of patients attending cardiac rehabilitation programmes and a high percentage not achieving weight, blood pressure and lipid targets. Researchers discovered that individuals left to themselves find it hard to adhere to recommended lifestyle changes and prescribed treatments. These include smoking cessation, changes in diet, increasing physical activity, controlling central obesity, blood pressure, cholesterol and glucose.

"Changing lifestyle behaviour -especially giving up smoking and loss of weight- is very hard to achieve" explains Catriona Jennings, Research Nurse Co-ordinator from the National Heart and Lung Institute, UK. "On their own, patients struggle and don't do well changing habits. Providing support and follow-up by dieticians, nurses and physiotherapists, made a big difference in helping patients reach their goals. Our team used behavioural techniques and expert advice to address individuals’ particular problems and personal challenges as they tried to follow prescribed treatment. The second key element was involving spouses: reducing weight or giving up smoking are difficult to accomplish if families do not feel concerned. Including them in the programme meant that the patient was not alone in trying to adopt a wholesome way of life, particularly changing eating habits. EUROACTION helped both patients and their families benefit from healthier lifestyles."

Thanks to EUROACTION a large majority of coronary and high risk patients, and their families, were recruited to a comprehensive preventive cardiology programme. EUROACTION patients reduced their consumption of saturated fat: three quarters of patients and their partners achieved the recommended fruit and vegetable consumption, compared to just over a third of usual care patients and twice as many met the recommended weekly intake of oily fish. Partners of EUROACTION patients showed the same trend of change for diet. Over half of patients stopped smoking and remained non-smokers after one year.

Physical activity targets of 30-45 minutes of exercise four to five items per week were achieved by twice as many EUROACTION patients as compared to usual care patients, and partners of EUROACTION patients also increased their physical activity.
Improvements in prescription of cardio protective therapies (ACE inhibitors and statins) were also observed in EUROACTION.

“Helping patients to make healthy lifestyle changes and take medicines poses considerable challenges for cardiology and general practice. EUROACTION shows that support from a multidisciplinary health care team and family involvement makes a real difference” explains Prof David Wood, FESC, Imperial College London, who coordinated the study. “EUROACTION showed that we can achieve lifestyle and risk factor targets in a large majority of patients. We now have to work towards establishing preventive cardiology programmes which are accessible by all coronary and high risk patients across Europe. Cardiovascular disease is the main cause of death in Europe. EUROACTION shows us a practical way of reducing the burden of heart disease and stroke.”

Notes:

European Society of Cardiology recommendations for CVD Prevention:

• Stop smoking
• Make healthy food choices (eat more fruits and vegetables, whole grain cereals, oily fish and omega-3 fatty acids)
• Be physically active ( at least 30 mn per day)
• Achieve a body-mass index (BMI) of less than 25 kg/m
• Keep a blood pressure of lower than 140/90 mm Hg
• A cholesterol concentration of less than 5.0 mmol/L
• A LDL cholesterol concentration of less than 3.0 mmol/L
• Control blood glucose
• Use appropriate prophylactic drugs when necessary
• Screen close relatives of patients with premature cardiovascular disease

Conclusion: