Four-year follow-up of the Choice of Health Options In prevention of Cardiovascular Events randomized controlled trial

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 47 +/- 6 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 (n = 72) or CHOICE (n = 72) comprising the tailored risk factor reduction packaged as a clinic visit and 3 months phone support. A contemporary CR reference group were also recruited (n = 64). 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 4.0 +/- 0.1 vs. 4.2 +/- 0.1 mmol/l, P = 0.05), significantly better systolic blood pressure (mean 132.2 +/- 2.1 vs. 136.8 +/- 2.0 mmHg, P = 0.01), physical activity scores (1200 +/- 209 vs. 968 +/- 196 metabolic equivalent min/week, P = 0.02) and proportion with three or more risk factors above national targets (20 vs. 42%, P = 0.02). 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.