Efectividad de una estrategia de intervención preventiva, basada en entrevistas telefónicas estructuradas, en una población laboral con riesgo cardiovascular moderado/alto

ResumenObjetivoEvaluar la efectividad de una estrategia de intervención preventiva sobre el estilo de vida, basada en entrevistas telefónicas.DiseñoEstudio de intervención cuasiexperimental.EmplazamientoServicio de Prevención de Ibermutuamur (Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social).Participantes4.792 trabajadores con nivel de riesgo cardiovascular (RCV) moderado/alto en el reconocimiento médico laboral (RML) que otorgaron su consentimiento. Se excluyeron los sujetos con antecedentes de enfermedad cardiovascular o que recibían tratamiento antihipertensivo, hipolipemiante o antidiabético.IntervenciónSe pudo contactar telefónicamente con 3.085 trabajadores, a los que se realizó seguimiento en los meses primero, cuarto y octavo tras el RML, enfatizando recomendaciones cardiosaludables. Al resto de trabajadores (n=1.707), solo se les realizó el RML inicial y final.Mediciones principalesEl RCV se estimó según el modelo SCORE europeo. Todos los sujetos recibieron un informe, una carta dirigida a su médico de atención primaria con los factores de RCV detectados, su nivel de riesgo y recomendaciones sobre modificación del estilo de vida.ResultadosEl 71,5% de los trabajadores eran mayores de 45 años, el 95,0% varones, el 76,6% trabajadores manuales y el 69,7% fumadores. Ambos grupos mostraron mejoría en los parámetros lipídicos, presión arterial, abandono del hábito tabáquico y RCV global en el segundo RML. El grupo A presentó una mayor mejoría en la presión arterial, lípidos (excepto colesterol-HDL), índice de masa corporal, glucemia, abandono del hábito tabáquico (23,5% vs 19,4%, p=0,001) y en el estrato de riesgo (46,6% vs 37,7%, p=0,0001). Un 52,9% de los trabajadores declaró haber llevado la carta informativa a su médico de Atención Primaria, que aconsejó modificar la dieta (47%), o añadir tratamiento antihipertensivo (19,5%), hipolipemiante (16,7%), antidiabético (4,4%) y antitabaco (2,9%).ConclusionesLa estrategia de intervención sobre el estilo de vida, basada en entrevistas telefónicas, en trabajadores de RCV moderado-alto, puede ser efectiva. El envío de información preventiva y la participación de Atención Primaria pueden contribuir, per se, a los cambios positivos observados.

ObjectiveThis study assesses the effectiveness of a structured telephone survey on cardiovascular prevention, in modifying lifestyle, on cardiovascular risk parameters, percentage of smoking cessation and overall cardiovascular risk (CVR).DesignQuasi-experimental study of preventive intervention.SettingIbermutuamur (Spanish Accident and Health Insurance Company). Centres established throughout Spain.ParticipantsA total of 4,792 workers with moderate/high cardiovascular risk who had agreed to be contacted by phone. Subjects with a previous diagnosis of cardiovascular disease and those receiving treatment for hypertension, hypercholesterolemia or diabetes were excluded.InterventionA final total of 3,085 workers were contacted and were followed up by telephone surveys on the first, fourth and eighth month after the initial check up (CU) in order to emphasise cardiovascular health advice (Group A); we failed to contact 1,707 workers, who only attended the baseline and one year CUs (Group B).Principal outcomesCUs included medical records and physical examination, with two blood pressure measurements, Body Mass Index (BMI), and biochemical parameters.Cardiovascular risk was stratified following the European cardiovascular SCORE. Individuals with a relative risk higher than 4 were also considered as high-risk. All workers were informed about their cardiovascular risk profile (CVRF) and healthy cardiovascular lifestyle measures. They were also given a letter for their General Practitioner (GP) to inform them on the worker's cardiovascular risk level.ResultsA total of 71.5% of the workers were over 45 years, 95.0% males, 76.6% manual workers (“Blue Collar”) and 69.7% smokers. Both groups showed improvement in lipid parameters, blood pressure, smoking cessation and overall cardiovascular risk in the second CU. There were significant differences in favour of Group A as regards blood pressure, lipids (except HDL cholesterol), BMI, glycaemia, smoking cessation (A: 23.5%/B: 19.44%, P=0.001) and CVR stratum improvement (A: 46.6%/B: 37.7%, P=0.0001). The large majority (85%) of workers read preventive recommendations; 33% knew their risk level and 73% knew their CVRF. 52.9% gave the letter to the GP, which led them to start therapies on diet (47%), hypertension (19.5%), dyslipidaemia (16.7%), diabetes (4.4%) and smoking (2.9%) and no changes were made in 36.5% of cases.ConclusionsThe results of this study suggests that cardiovascular prevention strategy based on structured telephone surveys on high/moderate CVR subjects to promote lifestyle changes could be effective at reducing CVR. A clinical trial is required for confirmation. Sending information on CVRF following routine medial CUs and Primary Care involvement, could contribute to the positive changes observed.