Randomized trial of cardiovascular prevention in Norway combining an in-hospital lifestyle course with primary care follow-up: the Hjerteløftet study.

AIMS: Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention programme based on the existing Norwegian health care system. METHODS AND RESULTS: In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention programme including a hospital-based lifestyle course and primary care follow-up or to a control group (CG). The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores, national and international (NORRISK, NORRISK 2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors. After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the CG; absolute difference in mean delta score in the IG (n = 305) compared to mean delta score in the CG (n = 296): -0.92, 95% CI: -1.48 to -0.36, P = 0.001. The results for NORRISK 2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (P = 0.0028) and with metabolic syndrome (P < 0.0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n = 9), CG (n = 16). CONCLUSION: In subjects with elevated cardiovascular risk, a newly developed prevention programme, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits.The study protocol was registered in ClinicalTrials.gov (NCT01741428).

Patients with COPD: Exploring patients' coping ability during an interdisciplinary pulmonary rehabilitation programme: A qualitative focus group study.

AIMS AND OBJECTIVES: To investigate experiences that contribute to enhancing patients' ability to cope with COPD during interdisciplinary in-hospital pulmonary rehabilitation programmes. BACKGROUND: Patients with COPD often experience difficulties accepting their life situation as well as reduced levels of activity and social interaction. Despite the large body of research conducted on interdisciplinary collaboration and coping, few studies have examined patient perspectives of why and how pulmonary rehabilitation actually contributes to helping patients with COPD to cope with their illness. DESIGN: Qualitative design. METHODS: The data consist of qualitative focus group interviews with 17 participants, divided into three focus groups. The data were analysed using a thematic analysis approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS: The patients described a lack of knowledge and understanding of their illness. In addition, they felt that their illness imposed limitations on their lifestyle and social interaction. Support from healthcare professionals during pulmonary rehabilitation proved to be vital, yet the lectures and consultations they received were described as general and sometimes rushed. The patients reported a positive effect from undergoing pulmonary rehabilitation, but a loss of motivation after returning home. CONCLUSION: The findings indicate that gaining better health competence during pulmonary rehabilitation contributes to enhancing patients' coping ability. Moreover, patients found it valuable to meet people in a comparable situation and to feel respected by healthcare professionals. Nevertheless, taking an individual empowerment-oriented approach and focusing on the return home seem to be significant aspects of the patients' improved and lasting ability to cope after pulmonary rehabilitation. RELEVANCE TO CLINICAL PRACTICE: Patients with COPD should be offered pulmonary rehabilitation because it has proven to have a positive effect on coping ability. Different follow-up measures are vital after pulmonary rehabilitation to maintain motivation after returning home.