Related Experiment Video
Updated: Mar 30, 2026
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice
A W Murphy1, M E Cupples2, E Murphy1
1Discipline of General Practice, National University of Ireland, Galway, Ireland.
Insights
A 6-year follow-up study found that an initial reduction in hospital admissions for coronary heart disease (CHD) patients was not sustained. This complex intervention in primary care did not show long-term benefits in hospital admissions, mortality, or risk factor control.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Primary Care
Background:
- Coronary heart disease (CHD) management requires effective primary care interventions.
- Previous studies indicated short-term benefits of a complex intervention on hospital admissions.
Purpose of the Study:
- To evaluate the long-term effectiveness (6-year follow-up) of a complex primary care intervention for patients with established coronary heart disease.
- To assess the sustained impact on hospital admissions, mortality, and cardiovascular risk factors.
Main Methods:
- A 6-year follow-up of a cluster randomised controlled trial involving 48 general practices.
- Included 903 patients with established coronary heart disease at baseline.
- Intervention involved tailored patient/practitioner plans, training, and recall systems; control group received usual care.
Main Results:
- No significant differences were observed between intervention and control groups in total or cardiovascular hospital admissions at 6 years.
- Mortality rates (15% vs. 16%) and control of systolic blood pressure and total cholesterol also showed no significant differences.
- Initial 18-month benefits in reduced hospital admissions were not maintained long-term.
Conclusions:
- The complex primary care intervention's positive effects on hospital admissions were not sustained at the 6-year follow-up.
- No long-term differences in mortality or cardiovascular risk factor control were detected.
- Continuous assessment of previously effective health programs is crucial for policymakers.
Objective:
To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease.
Design:
A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction).
Setting:
48 general practices in the Republic of Ireland and Northern Ireland.
Participants:
903 patients with established coronary heart disease at baseline in the original trial.
Intervention:
The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased.
Primary Outcome:
hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control.
Results:
At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol.
Conclusions:
Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes.
Trial Registration Number:
Current Controlled Trials ISRCTN24081411.
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:21Rheumatic Heart Disease III: Medical Management
02:20Longitudinal Research
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:30Preventive Healthcare Services
01:27Coronary Artery Disease V: Interprofessional Care