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Table 1 Characteristics of prevention programs aimed at reducing ischaemic heart disease burden in rural Australia

From: A systematic review of published interventions for primary and secondary prevention of ischaemic heart disease (IHD) in rural populations of Australia

Author, year of publication

Year(s) of study

Intervention strategies

Participants, follow up

Outcome measures

Results

Conclusions

Aoun & Rosenberg, 2004 [17]

2000–2001

7 week cardiac rehabilitation program

N = 203 patients with current CVD diagnosis, n = 159 controls. Followed up at post program, 3, 6 and 12 months

Self-reported changes in:

 

Cardiac Rehab programs in rural areas are successful in reducing risk factors for IHD and improving quality of life

-WT

-WT: ↓ 0.5 kg

-PA (6 min walk test)

(p = 0.004)

-BP,

-PA: 431.6 m to 469.6 m (p < 0.001)

-Quality of life scores (QoL)

-BP: NS, p value not reported

-QoL: 80.69 (15.9) to control 71.6 (18.86) (p = 0.04)

Burgess et al., 2015 [22]

2012–2014

Cardiac prevention screening services within primary health teams

Aboriginal clients aged 20 years and over, N = 2586 identified as high risk. Followed up every 3 months for two years

Achievement of target (not compared to baseline for significance):

Achieved target post program:

This type of program is a feasible way of reducing IHD risk factors in rural indigenous populations

-BP

-BP: 57 %

-TC

-TC : 40 %

No control group

-% Stopped smoking

-Stopped smoking: 50 %

Carrington and Stewart, 2015 [18]

2009–2010

Nurse-led screening and education program

N = 530, pre/post follow up design, no control group. Followed up at 6 months

Mean change in

-BP diastolic: ↓ 4 mmHg Systolic: ↓ 1 mmHg

Feasibility of a nurse-led screening and intervention was shown for a rural population

-BP

-TC

-WT (kg)

-TC: ↓ 0.6 mmol/L

-BMI

-WT: ↓ 1.0 kg

-BMI: ↓ 0.3mkg2

Higginbotham et al., 1999 [19]

1980–1990s (exact years not specified)

Whole community intervention

N = 359, no control group, but rates compared to nearby region

Change in

Intervention area:

Whole community interventions can have multiple positive impacts in rural communities and possibly reduce IHD burden if implemented with consideration of community needs and subgroups

-IHD Mortality (age standardised rates (per 100,000))

Women (35-64y)

Fatal MI: −14.2 (95 % CI: −26.0, −2.4)

9 year data collection phase

-Non-fatal MI rates,

Non-fatal MI: 1.7 (95 % CI: −4.4, 7.9)

-Case fatality compared to non-intervention region

Men (35-64y)

Fatal MI: −10.9 (95 % CI: −18.2, −3.6)

Non-fatal MI: 3.2 (95 % CI: −0.6, 7.0)

Rates declined faster in intervention population compared to than non-intervention region

Krass et al., 2003 [20]

Year(s) of intervention not specified

Pharmacy screening and education program

N = 389 adults in regional area, followed up from baseline to 3 months, no control group

From baseline to 3 months:

% Inactive

Community Pharmacies have the potential to increase resource provision in rural areas and can be effective at reducing risk factors for IHD

Cohort 1

Change in

57 % to 44 % (p < 0.0001) Cohort 2

-BP

-TC

-% Current smokers

50 % to 44 % (p = 0.01)

-% Not meeting PA recommendations

% Smokers = No change

-% Of people by BMI category

Both Cohorts:

Mean TC: ↓ 0.26 mmol/L (95 % CI 10–0.42) (p < 0.003).

BP: ↓ 10.5 mmHg (95 % CI 4.0-16.9) in mean systolic BP within Cohort 1 (p = 0.012), no difference for cohort 2.

BMI = NS (p value NR)

Kerr et al., 2008 [23]

Year(s) of intervention not specified

Exercise and cardiovascular monitoring program

N = 164 war veterans, followed up at 3, 6, 12 months

3 monthly follow up:

12 months:

This type of program was shown to be effective at reducing risk factors in a high risk, regional population of males

-Diastolic and systolic BP (mmHg)

Resting HR:↓ 4.0 bmp

- HR (bpm)

Diastolic BP: ↓ 6.4 mmHg

Systolic BP: ↓ 8.4 mmHg (p = <0.05). Weight (kg) :NS

Ray, 2001 [21]

Year(s) of intervention not specified

Once-off mobile heart screening program

N = 135 adults aged 30–69 years followed p 6 months post intervention

Self-report change in health behaviour after screening

Self-report health behaviours:

Heart risk screening can be a motivator for health behaviour change

76 = positive change

59 = no change

Rowley et al., 2000 [24]

1993–1995

Lifestyle education program

Aboriginal community participants

Change in risk factors overtime (Intervention group either compared BL or to control):

-no significant change in dietary and physical activity when compared to controls.

Some short term changes were not sustained in metabolic profiles from this intervention, however this program was found to be sustainable for this type of rural community

N = 32 intervention,

N = 17 controls

followed up at, 6 months, 2 years

-BMI

 

-Fasting glucose

-BMI: ↓from BL at 6 months (to control: p = 0.012), 12 months: NS (p = NR)

-Fasting glucose:

Positive changes in awareness and behavioural risk factors were noted

6 months:↓ 0.9 mmol (intervention to baseline p = 0.021)

- Glucose tolerance (oral glucose tolerance test (OGTT))

Intervention to control : NS (p = 0.132)

−2 h post -OGTT:

-plasma insulin

6 months: ↓ 1.6 mmol/l (p = 0.01 to BL)

-triglyceride concentration

Intervention to control: NS p = 0.154

-Fasting insulin: Intervention to control NS (p = 0.103)

-Fasting triglycerides: NS (p = 0.158)

  1. Abbreviations: BL baseline, BMI body mass index, BP blood pressure, HR heart rate, bpm beats per minute, IHD ischaemic heart disease, MI myocardial infarction, NS not significant, NR Not reported, OGTT oral glucose tolerance test, PA physical activity, TC total cholesterol, QoL quality of life, WT weight (kg), ↓: decrease