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

• In hospitals for coronary patients and their families
• In primary care for individuals at high risk of developing cardiovascular disease and their partners

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.

A cluster randomised controlled trial in hospital and general practice with clinical follow-up at 16 weeks and 1 year

8 countries 24 centres 10,000+ subjects

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

Structure of the Programme in
Hospital and Primary Care
Identification and recruitment Multi-disciplinary initial assessment
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
16 week assessment
(hospital only)
One year follow-up

Lifestyle change
Healthy eating,
Weight management
Smoking cessation
Increasing
Physical activity
• 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


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

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

Measuring height and weight 
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

 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





Non-equipment based weekly supervised programme
Tailored physical activity advice
Monitored
Progressive
Thiene, Italy


Identification of local facilities
Philosophy of empowerment
Valencia, Spain





 Facilities
 Specialist schemes
 Experts
 Activities available

Goal setting and tracking progress with the Personal
Record Card

Index Event: Coronary Patients High Risk Patients
35%
48%
17%
AMI
UA
SA
69.9 % Male
Mean age overall 62.5 years
32%
42%
26%
SCORE
BP &
Lipids
Diabetes
49.8 % Male
Mean age overall 62.0 years

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

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

Change in proportion of patients achieving the European targets for a healthy diet from initial assessment to 1 year
Coronary Patients High Risk Patients
5
0
15
10
25
20
30
+15.8%
(2.2 to 29.3)*
25
9
Fruits and vegetables >400 g/day
+11.8%
(-2.1 to 25.6)
24
10
+11.4%
(0.6 to 22.1)*
14
3
Fish > 20 g/day Oily fish > 3 times/week
 Intervention  Usual Care * p<0.05
+23.6%
(9.1 to 38.2)*
30
25
20
15
10
5
0
27
+16.5%
(-0.1 to 33.1)
20
+2.2%
(-1.7 to 6.2)
4
Fruits and vegetables >400 g/day
4
6
4
Fish > 20 g/day Oily fish > 3 times/week

Change in proportion of patients participating in moderate intensity activity ≥4 times/week
≥30minutes from initial assessment to 1 year
Coronary Patients
+ 28.1% (13.9 to + 42.3)*
15
10
30
25
20
5
27
0.2
-10
-15
10
5
0
-5
30
25
20
15
0
 Intervention  Usual Care * p<0.05
High Risk Patients
+ 32.9% (1.8 to 53.9)*
24
-10

Mean change in BMI in those ≥25kg/m² and from initial assessment to 1 year**
Coronary Patients
-0.69 kg/m² (-1.03 to -0.34)*
High Risk Patients
-2.8 kg/m² (-13.1 to +7.5)
0.5
0.4
0.3
0.2
0.1
0
-0.1
-0.2
-0.3
-0.4
-0.3
0.4
0.2
0.1
0
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
-0.5
0.1
 Intervention  Usual Care * p<0.05 **random subsample in usual care

Mean change in waist circumference in men
≥94cm and women ≥80cm from initial assessment to 1 year**
Coronary Patients
-0.8 cm (-3.7 to 2.1)
High Risk Patients
-1.61 cm (-2.61 to -0.61)*
-0.8
-1
-1.2
-1.4
-1.6
0
-0.2
-0.4
-0.6
-1.5
-0.8
0
-0.2
-0.4
-0.6
-0.8
-1
-1.2
-1.4
-1.6
-1.8
-1.66
-0.21
 Intervention  Usual Care * p<0.05 **random subsample in usual care

%
60
50
40
30
20
10
0
31
Distribution of Waist Circumference at One year – All Patients
Hospital
*OR 0.61 (0.39 to 0.97), p=0.04
General Practice
*OR 0.70 (0.53 to 0.93), p=0.02
%
60
57 50
51
40
40
30
29
22 26 20
25
27
23
15
10
0
Ideal Level 1 Level 2 Ideal Level 1 Level 2
54
*Proportional odds model

The nurse-led multidisciplinary EUROACTION family based 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.

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

solely sponsored by an unconditional educational grant from Astra Zeneca