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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

Author

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  • 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
    Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment, 3720 MA Bilthoven, 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
    Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands)

  • Tobias N. Bonten

    (Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands)

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.

Suggested Citation

  • Emma A. Nieuwenhuijse & Rimke C. Vos & Wilbert B. van den Hout & Jeroen N. Struijs & Sanne M. Verkleij & Karin Busch & Mattijs E. Numans & Tobias N. Bonten, 2023. "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," IJERPH, MDPI, vol. 20(6), pages 1-17, March.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:6:p:5040-:d:1095515
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    References listed on IDEAS

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    1. Celeste Van Rinsum & Sanne Gerards & Geert Rutten & Nicole Philippens & Ester Janssen & Bjorn Winkens & Ien Van de Goor & Stef Kremers, 2018. "The Coaching on Lifestyle (CooL) Intervention for Overweight and Obesity: A Longitudinal Study into Participants’ Lifestyle Changes," IJERPH, MDPI, vol. 15(4), pages 1-27, April.
    2. Rita Faria & Manuel Gomes & David Epstein & Ian White, 2014. "A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials," PharmacoEconomics, Springer, vol. 32(12), pages 1157-1170, December.
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