Secondary preventive, nurse based, telephone follow-up for reduction of cardiovascular events after acute coronary syndrome or stroke

ISRCTN ISRCTN30433343
DOI https://doi.org/10.1186/ISRCTN30433343
Secondary identifying numbers N/A
Submission date
04/12/2014
Registration date
26/01/2015
Last edited
20/11/2024
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English Summary

Background and study aims
A substantial proportion of mortality, morbidity and disability rates in Sweden and internationally is due to myocardial infarctions and strokes. Effective treatments to avoid another event or death are available but the use of these treatments in routine care needs to be improved. The aim of this study is to see whether long-term follow-ups after a myocardial infarction or stroke by specially trained cardiovascular nurses (treatment group) provide a better use of preventive treatment compared to routine follow-ups in primary care (control group) and whether the risk of death or another myocardial infarction or stroke decrease?

Who can participate?
All patients diagnosed with a myocardial infarction or stroke over a period of approximately five years in the county of Jämtland, treated at the county’s only hospital, Östersund Hospital (Sweden).

What does the study involve?
In the treatment group the goal is to rapidly reach and then maintain set treatment targets for blood pressure and blood lipids. Patients in the control group will receive today’s standard of care as usual given by their general practitioner.

What are the possible benefits and risks of participating?
Not provided at time of registration

Where is the study run from?
The study is run from Östersund Hospital. Östersund Hospital is the only hospital in the county of Jämtland, Sweden. All patients will be recruited from the county of Jämtland.

When is the study starting and how long is it expected to run for?
January 2010 to December 2017

Who is funding the study?
The study is funded by The Research and Development Unit at Jamtland County Council (Sweden).

Who is the main contact?
Thomas Mooe
thomas.mooe@umu.se

Contact information

Prof Thomas Mooe
Scientific

Dept. of Public Health and Clinical Medicine, Östersund, Umea University
Hus 10 Plan 5
Östersund
SE-83183
Sweden

Phone +4663154046
Email thomas.mooe@umu.se

Study information

Study designSingle-centre randomized open controlled trial with two parallel groups
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typePrevention
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleSecondary preventive, nurse based, telephone follow-up for reduction of cardiovascular events after acute coronary syndrome or stroke: a randomised, controlled, population based study
Study acronymNAILED CV (Nurse based, Age independent Intervention to Limit Evolution of Disease after CardioVascular events)
Study hypothesisWe hypothesised that the NAILED CV (Nurse based, Age independent Intervention to Limit Evolution of Disease after CardioVascular events) Outcome trial would reduce cardiovascular events more effectively than usual care
Ethics approval(s)The Regional Ethical Review Board, Umeå University, Umeå, Sweden approved on 16/12/2009, ref: Dnr 09-142M, and 10/06/2013, ref: Dnr 13-204-32M
ConditionAcute coronary syndrome, stroke and transient ischemic attack
InterventionA study nurse will contact patients randomised to the intervention group by phone 1 month after discharge. Before the call a blood sample for lipids will be taken and a standardised blood pressure control will be performed. Blood pressure will be measured after 5 minutes in the sitting position and after 1 minute standing. The tests will be performed by a district nurse, or, for patients in the intervention group living close to the hospital, by a study nurse. Self reported compliance with medication, tobacco use and physical activity will be recorded. During the call the patient will be informed about the test results and if a change in medication is necessary. Tobacco use, physical activity and dietary habits will be discussed. Smoking cessation will be supported. Physical activity of moderate intensity 30 minutes or more most days of the week will be encouraged but also adjusted to the individual patients capacity. Dietary advice to reduce saturated fat and increase the intake of fruit and vegetables will be given. If the patients cholesterol or blood pressure values are above target medication will be adjusted after contact with a study physician. Repeat tests will be taken within approximately 4 weeks and further adjustments made if necessary until target values are reached or no further changes are reasonable. The same routine will be applied after 12 months and thereafter early. The target values are: blood pressure <140 / <90 mmHg (optionally <140 / <85 mmHg in diabetic patients), total cholesterol < 4.5 mmol/l, and low density lipoprotein (LDL) < 2.5 mmol/l (<1.8 in diabetic subjects) to comply with local guidelines.

Patients randomised to the usual care group will also be contacted by phone 1 month after discharge after blood pressure and lipid profile measurements. Self reported compliance, tobacco use and physical activity will be recorded. Their general practitioner who receives the test results (lipid profile and blood pressure) will provide all medical care and no additional intervention will be given as a result of participation in the study. The same routine will be applied after 12 months and thereafter yearly.
Intervention typeOther
Primary outcome measureMajor adverse cardiovascular events identified at the end of trial by reviewing patients medical records and by the Swedish National Patient Register and the Swedish Cause of Death Register defined as:
1. Non-fatal major coronary event: myocardial infarction or coronary revascularisation
2. Non-fatal stroke
3. Cardiovascular death
Secondary outcome measuresMajor adverse cardiovascular events identified at the end of trial by reviewing patients medical records and by the Swedish National Patient Register and the Swedish Cause of Death Register.
1. Separate assessment of the individual components of the primary endpoint
2. Transient ischemic attack
3. All-cause mortality
4. Separate assessment of the acute coronary syndrome and the stroke / TIA cohorts
Overall study start date01/01/2010
Overall study end date06/04/2020

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants1900
Total final enrolment1833
Participant inclusion criteria1. All patients living in the county of Jämtland, Sweden, and hospitalised with a diagnosis of an acute coronary syndrome (ACS, acute myocardial infarction or unstable angina pectoris), stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) will be assessed for inclusion
1.1. Östersund hospital is the only hospital in the county and all patients, terminal care excluded, with symptoms of an ACS or suspected stroke or TIA are referred for diagnostic evaluation. A routine for identification of all patients in the hospital with a possible ACS or stroke/TIA has been established in previous studies.
2. All patients with a physical and mental capacity to communicate by telephone
Participant exclusion criteria1. Patients with severe disease
2. Aphasia
3. Dementia
4. Deafness
5. Participation in another trial
Recruitment start date01/01/2010
Recruitment end date31/12/2014

Locations

Countries of recruitment

  • Sweden

Study participating centre

Cardiology, Dept. of Public Health and Clinical Medicine Umea University
Östersund
SE-83183
Sweden

Sponsor information

Jamtland County Council (Sweden)
Government

The Research and Development Unit
Jamtland County Council
Box 654
Östersund
SE-83127
Sweden

Phone +4663153000
Email jamtlands.lans.landsting@jll.se

Funders

Funder type

Government

The Research and Development Unit, Jamtland County Council (Sweden)

No information available

Results and Publications

Intention to publish date30/06/2021
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planMain outcome data: anticipated publication date (indicative) 1st September 2018.
IPD sharing planThe datasets generated during and/or analysed during the current study are/will be available upon request

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article 02/08/2021 08/02/2023 Yes No
Other publications 11/11/2024 20/11/2024 Yes No

Editorial Notes

20/11/2024: Publication reference added.
08/02/2023: Publication reference added.
11/05/2020: The following changes have been made:
1. The intention to publish date has been changed from 31/12/2020 to 30/06/2021.
2. The total final enrolment number has been added.
06/01/2020: The following changes have been made:
1. The overall trial end date has been changed from 31/12/2017 to 06/04/2020.
2. The intention to publish date has been changed from 31/12/2018 to 31/12/2020.
3. A secondary outcome measure has been added.