Background: Cardiovascular secondary preventive recommendations are often not reached. We investigated\nwhether a nurse-led telephone-based follow-up could improve the implementation of a new guideline within a\nyear after its release.\nMethods: In February 2013, a new secondary preventive guideline for diabetic patients was released in the\ncounty of JÃ?¤mtland, Sweden. It included a changed of the low-density lipoprotein cholesterol (LDL-C) target\nvalue from <2.5 mmol/L to <1.8 mmol/L. In the Nurse-Based Age-Independent Intervention to Limit Evolution of Disease\n(NAILED) trial, patients with an acute coronary syndrome, stroke, or transient ischemic attack were randomized to\nsecondary preventive care with nurse-based telephone follow-up (intervention) or usual care (control). Patient data were\nobtained from the NAILED trial to study the implementation of the new LDL-C guideline by comparing telephone\nfollow-up with usual care. The Mannââ?¬â??Whitney U-test was used for continuous variables, and Personââ?¬â?¢s Ãâ?¡2 test was\nused for categorical variables to assess between-group differences.\nResults: Out of the 1267 patients that entered the study period, 101 intervention and 100 control patients with diabetes\nfulfilled the inclusion criteria and completed the study period. Before the guideline change, 96 % of the intervention\npatients and 70 % of the control patients reached the target LDL-C value (p < 0.001). After the guideline change, the\ncorresponding respective proportions were 65 % and 36 % (p < 0.001). The main reason that intervention patients did\nnot achieve the target LDL-C value was that they received full-dose treatment; for control patients, the main reason was\nthat medication was not adjusted, for an unknown reason.\nConclusions: One year after a change in the cardiovascular secondary preventive guideline, nurse-based telephone\nfollow-up performed better than usual care to implement the new recommendation
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