Peer-Reviewed Journal Details
Mandatory Fields
Murphy, E,Vellinga, A,Byrne, M,Cupples, ME,Murphy, AW,Buckley, B,Smith, SM
2015
July
British Journal Of General Practice
Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis
Published
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Optional Fields
cardiovascular disease coronary artery disease general practice systematic review RANDOMIZED CONTROLLED-TRIAL HIGH CARDIOVASCULAR RISK CORONARY-ARTERY-DISEASE 5-YEAR FOLLOW-UP GENERAL-PRACTICE HEALTH-PROMOTION CLINICS EFFICACY PROGRAMS
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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.
10.3399/bjgp15X685681
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