Van Gool & Bridges
TABLE C- 4: EFFECTIVENESS MEASURES
Strategy Target Existing CHD death New CHD death rate per
rate per 100,000 100,000, if strategy
implemented.
|
Community |
High risk groups |
Male |
Female |
Male |
Female |
|
Low SES areas |
24224 |
IlO24 |
22724 |
10324 | |
|
Selected migrant groups |
23 724 |
14724 |
22324 |
13824 | |
|
Aboriginal & TSI |
48624 |
20524 |
45624 |
19224 | |
|
Mass media |
Whole population |
19825 |
8225 |
19025 |
7925 |
|
Hospital |
People with CHD |
118926 |
49226 |
89226 |
36926_____________ |
24 Hoffmeister, H et al 1996, 'ReductionofCHD Risk Factors in the German CardiovascularPrevention Study’, Preventive Medicine',25'Λ35-
145.
Note: the authors estimate that their program reduced the risk of CHD by 6.3% overall. This figure has been applied to CHD rate amongst low
SES areas in the South Western Sydney region. The same risk reduction was used for both ethnic and ATSl groups, as several studies have shown
that well targeted programs, such as the German CVD Prevention study, can be effective with different types of high risk groups.
25 Several sources reported on the Stanford five city project. These are:
• Mant, D 1997, ‘Effectiveness of dietary intervention in general practice’, American Journal of Clinical Nutrition; 65(suppl): 1933S-8S.
• Fortman et al 1990, ‘Effect of long-term Community Health Education on blood pressure and hypertension control’, American Journal of
epidemiology, Vol. 132, No. 4.
• Winkleby, M et al. 1996, ‘The long term effects of cardiovascular disease prevention trial: the Stanford five-city project”, American Journal
OfPubIic Healtlr,86'Λ773-V779).
The Stanford project cannot be strictly seen as only a mass media campaign, as other educational materials were also distributed. However Mann
reports that a number of the five cities received mass media interventions, whilst others received mass media plus one-on-one advice to those who
sought it. Mant states that in the ‘mass media’ cities the CVD risk was reduced by approximately 2-3% (from the baseline). Winkleby et al
reports that over a 6-year period the CHD risk reduction was approximately 5 % over the control group. This report has taken a mid-point of 4%
reduction in CHD risk. Note that the overall mortality and morbidity effects of the Stanford project are yet to be reported. Significantly, the project
also showed a convergence of the control and treatment groups in a follow up study, 4 years after the end of the program.
26 Oldridge, N et al 1988, ‘Cardiac Rehabilitation after myocardial infarction: combined experience of Random Control Trials’, JAMA; 260:945-
950.
Oldridge reports that the pooled odds ratio of 0.75 for CVD deaths were significantly lower in the treatment group than the control group. In this
analysis a figure of 25% risk reduction for people with CHD was used. In a more recent study Campbell et al (1998) concludes that in their first year
secondary prevention clinics improved patients’ health and reduced hospital admissions.
69
Chere Project Report 11- November 1999