Edinburgh Napier University

  Objective: To determine if the improved risk factor profile at 1 year attributed to the Choice of Health Options In prevention of Cardiovascular Events (CHOICE) program was maintained at 4 years.
Design: Single-blind randomized controlled trial with post-hoc 476 months follow-up (76% complete).
Setting: Australian tertiary referral hospital.
Patients: Two hundred and eight acute coronary syndrome survivors.
Interventions: Acute coronary syndrome survivors not accessing cardiac rehabilitation (CR) were randomized to control (n¼72) or CHOICE (n¼72) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support. A contemporary CR reference group were also recruited (n¼64). Blinded risk assessment occurred at baseline, 1 and 4 years.
Main outcome measures: Total cholesterol, systolic blood pressure, smoking status, physical activity.
Results: One year improvements in all the modifiable risk factors achieved in CHOICE were maintained at 4 years. CHOICE and control were well-matched at baseline. At 4 years, there was a trend towards lower total cholesterol in CHOICE compared with controls (mean 4.00.1 vs. 4.20.1 mmol/l, P¼0.05), significantly better systolic blood pressure (mean 132.22.1 vs. 136.82.0 mmHg, P¼0.01), physical activity scores (1200209 vs. 968196 metabolic
equivalent min/week, P¼0.02) and proportion with three or more risk factors above national targets (20 vs. 42%, P¼0.02). Participants in CHOICE were at higher baseline risk than CR but at 4 years they had similar risk factor profiles.
Conclusion: Participants in CHOICE maintained favorable changes in coronary risk profile at 4 years compared with control, indicating that CHOICE is an effective long-term intervention among those not accessing facility-based CR.