The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial

Emma A. Nieuwenhuijse (), Rimke C. Vos, Wilbert B. van den Hout, Jeroen N. Struijs, Sanne M. Verkleij, Karin Busch, Mattijs E. Numans and Tobias N. Bonten
Additional contact information
Emma A. Nieuwenhuijse: Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
Rimke C. Vos: Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
Wilbert B. van den Hout: Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Jeroen N. Struijs: Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
Sanne M. Verkleij: Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
Karin Busch: Hadoks Chronische Zorg BV, 2517 JK The Hague, The Netherlands
Mattijs E. Numans: Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
Tobias N. Bonten: Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

IJERPH, 2023, vol. 20, issue 6, 1-17

Abstract: Objective: To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme “Healthy Heart”, addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. Design: A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost–utility analysis was performed. During the intervention period, “Healthy Heart” was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. Results: In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3–6 months and 12–24 months. Intervention versus control (95% CI) 3–6 months: weight: β −0.5 (−1.08–0.05); SBP β 0.15 (−2.70–2.99); LDL-cholesterol β 0.07 (−0.22–0.35); HDL-cholesterol β −0.03 (−0.10–0.05); physical activity β 38 (−97–171); diet β 0.95 (−0.93–2.83); alcohol OR 0.81 (0.44–1.49); quit smoking OR 2.54 (0.45–14.24). Results were similar for 12–24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: −0.10 (−0.20; 0.002); costs: EUR 106 (−80; 293)). Conclusions: For both the shorter (3–6 months) and longer term (12–24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.

Keywords: primary practice; preventative health care; cardiovascular risk; lifestyle factors; cost effectiveness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/20/6/5040/pdf (application/pdf)
https://www.mdpi.com/1660-4601/20/6/5040/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:20:y:2023:i:6:p:5040-:d:1095515

Access Statistics for this article

IJERPH is currently edited by Ms. Veronica You

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().