Jennifer Jones on behalf of the EUROACTION study group Department of Cardiovascular Medicine,

1. EUROACTION: Changes in diet and physical activity over one year in a family based preventive cardiology programme in hospital and general practice Jennifer Jones on behalf of the EUROACTION study group Department of Cardiovascular Medicine, Imperial College, London, UK

2. The Multidisciplinary family based EUROACTION Programme • In hospitals for coronary patients and their families • In primary care for individuals at high risk of developing cardiovascular disease and their partners

3. EUROACTION Aim • To raise the standards of preventive cardiology in Europe by demonstrating that the recommended European and national lifestyle, risk factor and therapeutic goals in cardiovascular disease prevention are achievable and sustainable in everyday clinical practice.

4. EUROACTION Study design • A cluster randomised controlled trial in hospital and general practice with clinical follow-up at 16 weeks and 1 year

5. EUROACTION 8 countries 24 centres 10,000+ subjects

6. Generalisable model of preventive cardiology care

7. Nurse-led multidisciplinary approach The EUROACTION team in Boldrini Hospital, Thiene, Italy The EUROACTION nurse and the lead GP in Hoensbroek, The Netherlands

8. Structure of the Programme in Hospital and Primary Care Multi-disciplinary initial assessment Identification and recruitment • Preventive Cardiology Programme • Empowering families to change their lifestyle: smoking, diet and physical activity • Blood pressure, blood cholesterol and blood glucose management • Compliance with cardio-protective medication • One to one and group approach • Supervised hospital and home exercise programme • Health promotion workshop programme One year follow-up 16 week assessment (hospital only)

9. Lifestyle change • No smoking • Saturated Fat: <10% total Energy • Fruits and vegetables: >400g/day • Fish: >20g/day • Oily Fish: >3 times/week • 30-45 minutes of physical activity at 60–75% of the average maximum heart rate on four-five days of the week • Weight reduction ≥ 5% • Waist <94 cm in men and <80 cm in women

10. Aim of the dietary intervention • To help patients and families to adopt a diet associated with lowest risk of atherosclerotic disease • To help patients and families to achieve a healthy weight and shape

11. Dietary Intervention • Individual Dietary Assessment of family habits • Anthropometric measures • Goal Setting • Education on Cardio-protective diet • Individualised and group advice • Regular monitoring and follow up

12. If weight loss identified as priority • European Recommendations • BMI: • <25kg/m2 • Waist: • Women <80cm; Men <94cm • Target weights set • 5-10% weight loss • Behaviour strategies • Weekly weigh ins • Portion sizes • Food diaries Measuring height and weight

13. Physical Activity • Individual Physical Activity Assessment • 7 day activity recall • Pedometer • Functional capacity • Functional limitation • Activity perceptions, barriers and motivators • Goal Setting • Education on Benefits of Physical Activity

14. The Supervised Exercise Programme in Hospital • Non-equipment based weekly supervised programme • Tailored physical activity advice • Monitored • Progressive Thiene, Italy • Identification of local facilities • Philosophy of empowerment Valencia, Spain

15. Physical Activity Advice in Primary Care •  Facilities •  Specialist schemes •  Experts • Activities available

16. Educational Materials Goal setting and tracking progress with the Personal Record Card

17. RESULTS

18. High Risk Patients Index Event: Coronary Patients 69.9 % Male Mean age overall 62.5 years 49.8 % Male Mean age overall 62.0 years

19. Hospital Arm Usual Care Intervention PARTNERS PATIENTS PARTNERS PATIENTS 1718 802 828 1694 Identification 307 646 1061 (67%)* Initial assessment 410 860 (82%)** Participation in the Programme 335 994 401 946 (89%)** One year assessment *Of those eligible **Of those who attended initial assessment

20. Primary Care Arm Usual Care Intervention PARTNERS PATIENTS PARTNERS PATIENTS 1752 830 805 1257 Identification NA 331 261 1118 (89%)* Initial assessment 204 947 (85%)** Participation in the Programme 363 1005 225 1019 (91%)** One year assessment *Of those eligible **Of those who attended initial assessment

21. Change in proportion of patients achieving the European targets for a healthy diet from initial assessment to 1 year Coronary Patients High Risk Patients +11.8% (-2.1 to 25.6) +15.8% (2.2 to 29.3)* +23.6% (9.1 to 38.2)* +11.4% (0.6 to 22.1)* +16.5% (-0.1 to 33.1) +2.2% (-1.7 to 6.2)  Intervention  Usual Care *p<0.05

22. Change in proportion of patients participating in moderate intensity activity ≥4 times/week ≥30minutes from initial assessment to 1 year High Risk Patients + 32.9% (1.8 to 53.9)* Coronary Patients + 28.1% (13.9 to + 42.3)*  Intervention  Usual Care *p<0.05

23. Mean change in BMI in those ≥25kg/m² and from initial assessment to 1 year** CoronaryPatients HighRiskPatients -0.69 kg/m² (-1.03 to -0.34)* -2.8 kg/m² (-13.1 to +7.5)  Intervention  Usual Care *p<0.05 **random subsample in usual care

24. Mean change in waist circumference in men≥94cm and women ≥80cm from initial assessment to 1 year** Coronary Patients High Risk Patients -0.8 cm (-3.7 to 2.1) -1.61 cm (-2.61 to -0.61)*  Intervention  Usual Care *p<0.05 **random subsample in usual care

25. Distribution of Waist Circumference at One year – All Patients Hospital General Practice *OR 0.61 (0.39 to 0.97), p=0.04 *OR 0.70 (0.53 to 0.93), p=0.02 *Proportional odds model

26. Conclusions The nurse-led multidisciplinary EUROACTION familybased programme achieved significantly better lifestyle changes for coronary and high risk patients in terms of a more healthy diet, reduction in abdominal obesity and increased physical activity compared to usual care.

27. Conclusions EUROACTION has set new standards of preventive cardiology care for coronary and high risk patients and their families in everyday clinical practice

28. EUROACTION A European Society of Cardiology demonstration project in preventive cardiology www.escardio.org/euroaction solely sponsored by an unconditional educational grant from Astra Zeneca