The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health
Research Stream: Regional Australians
Protecting Healthy Hearts was a 6 month study to evaluate the benefits of a nurse-led, self-management intervention program for reducing risk factors for Cardiovascular Disease (CVD) and Diabetes in a high risk, under-serviced population.
Full Study Title
Protecting Healthy Hearts
Department of Health and Ageing, Chronic Disease Self-Management/Lifestyle and Risk Modification Grant
Rationale for the Study
Regional Australians have been found to have high levels of antecedent risk for CVD that are disproportionate to metropolitan dwelling adults. An observational study of antecedent risk for CVD and related lifestyle factors [Healthy Hearts Beyond City Limits] was previously carried out in four regional locations to identify the community most likely to benefit from a pro-active prevention program.
The aim of the Protecting Healthy Hearts program was to evaluate the benefits of a nurse-led, self-management intervention program for reducing risk factors for CVD and diabetes in a high risk, under-serviced population. The emphasis of the intervention was to induce self-initiated behavioural change (with nurse support) to promote a healthier diet and lifestyle plan, enhance therapeutic adherence to medications and develop self care abilities.
The program used a random sample of the adult population aged over 18 years who responded to local newspaper(s) and radio station advertisements for a free health check. Overall, 530 self-selected individuals volunteered to participate, representing 7% of the adult population (based on place of usual residence). The data collection schedule included a self-administered questionnaire, clinical assessment, written summary reports, basic health education and in-depth nurse consultation to develop individualised self care and management plans (where appropriate). Individual targets and multidisciplinary strategies to reduce risk factors were applied. The primary endpoint was change in CVD risk factors.
During the Protecting Healthy Hearts Study, 121 (23%) out of 530 individuals screened over 7 weeks in Colac, Victoria, were identified at high risk according to the ranked GARDIAN (Green Amber Red Delineation of rIsk And Need) management system . Mean age was 54 ± 14 years (38% male). Blood pressure and body mass index (BMI) were above ideal levels for 42% and 27% of participants, respectively. A total of 182 (34%) participants had the constellation of risk factors which make up the metabolic syndrome and 126 (25%) people showed potential depression. At 6 months, 435 (82%) individuals returned who showed significant reductions in systolic/diastolic blood pressure of 4.0 [range -5.3, -2.7] / 1.3 [-2.1, 0.6] mmHg. Total cholesterol decreased by 0.6 [-0.7,-0.5] mmol/L and low density lipoprotein (LDL) cholesterol by 0.3 [-0.4,-0.2] mmol/L. Absolute cardiovascular disease risk and AUSDRISK decreased by 0.4% [-0.8%, -0.1%] and 0.3% [-0.5%,-0.1%], respectively.
Study Conclusions & Translational Potential
A nurse-led risk reduction clinic that employed the Protecting Healthy Hearts intervention was highly acceptable and popular in a regional community where health care resources are often limited. Retention rates were high. The intervention demonstrated sustainable improvements from baseline to 6 months in metabolic and heart health. There is potential for the intervention to be highly cost effective in reducing CVD events. The Protecting Healthy Hearts study confirmed the feasibility of a dedicated heart health service and provided proof of concept for the establishment of regional nurse-led clinics.
Funding from the NHMRC for a follow up trial has been requested. We propose to undertake a multi-centre, appropriately powered and pragmatic randomised controlled trial of an innovative, nurse-led, multidisciplinary prevention program. The Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) Study aims to minimise the high probability of developing advanced forms of CVD in adults living in regional communities in Victoria with the Metabolic Syndrome with or without a diagnosis of type 2 diabetes.