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Reviews
Murphy, E;Vellinga, A;Byrne, M;Cupples, ME;Murphy, AW;Buckley, B;Smith, SM
2015
July
Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis
Published
1
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RANDOMIZED CONTROLLED-TRIAL HIGH CARDIOVASCULAR RISK CORONARY-ARTERY-DISEASE 5-YEAR FOLLOW-UP GENERAL-PRACTICE HEALTH-PROMOTION CLINICS EFFICACY PROGRAMS
BackgroundIschaemic heart disease (IHD) is the most common cause of death worldwide.AimTo determine the long-term impact of organisational interventions for secondary prevention of IHD.Design and settingSystematic review and meta-analysis of studies from CENTRAL, MEDLINE (R), Embase, and CINAHL published January 2007 to January 2013.MethodSearches were conducted for randomised controlled trials of patients with established IHD, with long-term follow-up, of cardiac secondary prevention programmes targeting organisational change in primary care or community settings. A random effects model was used and risk ratios were calculated.ResultsFive studies were included with 4005 participants. Meta-analysis of four studies with mortality data at 4.7-6 years showed that organisational interventions were associated with approximately 20% reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79 (95% confidence interval (CI) = 0.66 to 0.93), and a RR for cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies reported mortality data at 10 years. Analysis of these data showed no significant differences between groups. There were insufficient data to conduct a meta-analysis on the effect of interventions on hospital admissions. Additional analyses showed no significant association between organisational interventions and risk factor management or appropriate prescribing at 4.7-6 years.ConclusionCardiac secondary prevention programmes targeting organisational change are associated with a reduced risk of death for at least 4-6 years. There is insufficient evidence to conclude whether this beneficial effect is maintained indefinitely.
LONDON
ROYAL COLL GENERAL PRACTITIONERS
0960-1643
460
468
10.3399/bjgp15X685681
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