A telephone reminder to enhance adherence to interventions in cardiovascular randomized trials: A protocol for a study within a trial (SWAT)

The impact of reduced adherence in randomized clinical trials is well documented in the literature. Nonadherence can negatively affect the trial sample size and estimation of the treatment effect. This protocol aims to evaluate the effects of a telephone call reminder on the adherence rates of participants to interventions in a cardiovascular randomized trial. This is a study within a trial (SWAT). The host trial is evaluating the effectiveness of a multidisciplinary 16-wk cardiovascular disease prevention program on risk factor profile among patients with carotid artery stenosis. Simultaneously, this SWAT will evaluate the effectiveness of telephone call reminders on the participants' adherence to the host trial intervention. The primary outcome is adherence to the protocol of the host trial. Secondary outcomes are level of adherence, number of dropouts, and time to drop out from the host trial.

Social inequality in awareness of cardiovascular risk factors in patients undergoing coronary angiography

BACKGROUND

In order to improve their risk profile, individuals need to be aware of the existence of cardiovascular (CV) risk factors. The awareness of CV risk factors has not yet been studied in patients undergoing coronary angiography.

PATIENTS AND METHODS

A total of 4,500 patients undergoing coronary angiography were asked to complete a questionnaire before the procedure. The patients were asked about their economic status, their education, their source of health information and were also asked to name CV risk factors.

RESULTS

The prevalence of coronary artery disease (CAD) (87%) and CV risk factors was high. Hypertension and hypercholesterolemia were the two most common CV risk factors and were found in two thirds of the patients. There were significant differences in the awareness of risk factors across the different levels of education. Only 8% of the men and 7% of the women could cite at least three risk factors. This percentage ranged from 4% of the patients with primary level of education to 11% and 20% of the patients with secondary and university levels of education, respectively (p < 0.001). More than 1 out of 10 patients did not know any CV risk factor. Smoking and hypercholesterolemia were the best identified CV risk factors in contrast to diabetes and hypertension. The primary care physician was the major source of information across all levels of education.

CONCLUSION

Awareness of CV risk factors is low in this high-risk population and associated with strong social inequalities. This information is alarming and will have to be addressed in order to improve outcomes in patients with CAD.

Do citizens have minimum medical knowledge? A survey

BACKGROUND

Experts defined a "minimum medical knowledge" (MMK) that people need for understanding typical signs and/or risk factors of four relevant clinical conditions: myocardial infarction, stroke, chronic obstructive pulmonary disease and HIV/AIDS. We tested to what degree Swiss adult citizens satisfy this criterion for MMK and whether people with medical experience have acquired better knowledge than those without.

METHODS

Questionnaire interview in a Swiss urban area with 185 Swiss citizens (median age 29 years, interquartile range 23 to 49, 52% male). We obtained context information on age, gender, highest educational level, (para)medical background and specific health experience with one of the conditions in the social surrounding. We calculated the proportion of MMK and examined whether citizens with medical background (personal or professional) would perform better compared to other groups.

RESULTS

No single citizen reached the full MMK (100%). The mean MMK was as low as 32% and the range was 0-72%. Surprisingly, multivariable analysis showed that participants with a university degree (n = 84; beta (95% CI) +3.7% MMK (0.4-7.1) p = 0.03), (para)medical background (n = 34; +6.2% MMK (2.0-10.4), p = 0.004) and personal illness experience (n = 96; +4.9% MMK (1.5-8.2), p = 0.004) had only a moderately higher MMK than those without, while age and sex had no effect on the level of MMK. Interaction between university degree and clinical experience (personal or professional) showed no effect suggesting that higher education lacks synergistic effect.

CONCLUSION

This sample of Swiss citizens did not know more than a third of the MMK. We found little difference within groups with medical experience (personal or professional), suggesting that there is a consistent and dramatic lack of knowledge in the general public about the typical signs and risk factors of relevant clinical conditions.

Guidelines--a missed opportunity

Progress is slow in the integration of coronary heart disease prevention into daily clinical practice by cardiologists and other physicians working in cardiology, internal medicine and primary healthcare. This is not due to a lack of professional recommendations on coronary prevention. As new knowledge has become available, new generations of recommendations have been published. In surveys of secondary prevention practice, risk factor recording and management falls short of these recommendations and there is considerable potential to further reduce the risk of another major ischemic event in patients with established coronary disease. The most recent recommendations from the Joint Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension reinforce the importance of secondary prevention and how they can be extended to primary prevention by targeting high-risk individuals in the general population. It is hoped that development of guidelines at a national level will ensure a common approach to coronary heart disease prevention throughout Europe.