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Community-Based lifestyle intervention in patients with coronary artery disease

the RESPONSE-2 trial


BACKGROUND: Among patients with coronary artery disease (CAD), improvement of lifestyle-related risk factors (LRFs) reduces cardiovascular morbidity and mortality. However, modification of LRFs is highly challenging. OBJECTIVES: This study sought to evaluate the impact of combining community-based lifestyle programs with regular hospital-based secondary prevention. METHODS: The authors performed a randomized controlled trial of nurse-coordinated referral of patients and their partners to 3 widely available community-based lifestyle programs, in 15 hospitals in the Netherlands. Patients admitted for acute coronary syndrome and/or revascularization, with ≥1 LRF (body mass index >27 kg/m(2), self-reported physical inactivity, and/or smoking) were included. All patients received guideline-based usual care. The intervention was based on 3 lifestyle programs for weight reduction, increasing physical activity, and smoking cessation. The primary outcome was the proportion of success at 12 months, defined as improvement in ≥1 qualifying LRF using weight (≥5% reduction), 6-min-walking distance (≥10% improvement), and urinary cotinine (200 ng/ml detection limit) without deterioration in the other 2. RESULTS: The authors randomized 824 patients. Complete data on the primary outcome were available in 711 patients. The proportion of successful patients in the intervention group was 37% (133 of 360) compared with 26% (91 of 351) in the control group (p = 0.002; risk ratio: 1.43; 95% confidence interval: 1.14 to 1.78). In the intervention group, partner participation was associated with a significantly greater success rate (46% vs. 34%; p = 0.03). CONCLUSIONS: Among patients with coronary artery disease, nurse-coordinated referral to a comprehensive set of community-based, widely available lifestyle interventions, with optional partner participation, leads to significant improvements in LRFs. (RESPONSE-2: Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2; NTR3937).

Reference Minneboo, M., Lachman, S., Snaterse, M., Jørstad, H. T., Ter Riet, G., Boekholdt, S. M., Scholte Op Reimer, W. J. M., Peters, R. J. G., & RESPONSE-2 Study Group (2017). Community-Based lifestyle intervention in patients with coronary artery disease: the RESPONSE-2 trial. Journal of the American College of Cardiology, 70(3), 318-327. https://doi.org/10.1016/j.jacc.2017.05.041
18 July 2017

Publication date

Jul 2017


Madelon Minneboo
Sangeeta Lachman
Marjolein Snaterse
Harald T Jørstad
Gerben Ter Riet
S Matthijs Boekholdt
Wilma J M Scholte Op Reimer
Ron J G Peters
RESPONSE-2 Study Group

Research database