Automatic aortic root segmentation and anatomical landmarks detection for TAVI procedure planning

Purpose: Minimally invasive trans-catheter aortic valve implantation (TAVI) has emerged as a treatment of choice for high-risk patients with severe aortic stenosis. However, the planning of TAVI procedures would greatly benefit from automation to speed up, secure and guide the deployment of the prosthetic valve. We propose a hybrid approach allowing the computation of relevant anatomical measurements along with an enhanced visualization.

Material and methods: After an initial step of centerline detection and aorta segmentation, model-based and statistical-based methods are used in combination with 3?D active contour models to exploit the complementary aspects of these methods and automatically detect aortic leaflets and coronary ostia locations. Important anatomical measurements are then derived from these landmarks.

Results: A validation on 50 patients showed good precision with respect to expert sizing for the ascending aorta diameter calculation (2.2?±?2.1?mm), the annulus diameter (1.31?±?0.75?mm), and both the right and left coronary ostia detection (1.96?±?0.87?mm and 1.80?±?0.74?mm, respectively). The visualization is enhanced thanks to the aorta and aortic root segmentation, the latter showing good agreement with manual expert delineation (Jaccard index: 0.96?±?0.03).

Conclusion: This pipeline is promising and could greatly facilitate TAVI planning.     

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade.

Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017.

Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p?=?.011) and from 4.1% to 1.8% for SAVR (p?=?.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p?<?.001) and from 87.2% to 91.6% for SAVR (p?=?.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4?±?8.4 to 3.7?±?3.4 days after TAVR (p?<?.001) and from 9.0?±?5.9 to 7.8?±?5.1 days after SAVR (p?<?.001).

Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915

• Key Messages

• This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis.

• Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade.

• Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.

     

Plasma Klotho concentrations predict functional outcome at three months after acute ischemic stroke patients

Background: The Klotho protects the cardiovascular system by protecting against cell apoptosis, inhibiting the production of reactive oxygen species, and modulating inflammation. We aimed to investigate relationship of plasma Klotho concentrations with functional outcome at 3 months after acute cerebral infarction.

Methods: We prospectively enrolled 262 first-ever acute cerebral infarction patients from whom a blood sample was acquired within 24?h of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. Functional outcome on admission and three months was evaluated.

Results: Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean?±?standard deviation of plasma Klotho concentrations was 312.7?±?153.3?pg/mL. As opposed to patients with good outcome, plasma Klotho levels were lower in the poor outcome group (207.8?±?96.2 vs. 342.5?±?153.5?pg/mL, p?=?.001). In multivariate analysis, increased plasma Klotho concentrations were independently associated with good functional outcome (Odds ratio: 2.42, 95% confidence interval: 1.45–4.04, p?<?.001).

Conclusions: Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke. We attribute these associations to the pleiotropic effects of Klotho in stroke and vascular diseases.

• Key message

• Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke.

     

Volume of embolic agents in uterine artery embolization for leiomyoma: relation to baseline MRI

Purpose: To assess whether pre-procedural MRI findings predict the volume of tris-acryl gelatin microspheres (TAGM) used in uterine artery embolization (UAE) for leiomyomas.

Material and methods: This was a retrospective, single-institution study. Between June 2014 and December 2017, 73 patients with leiomyomas underwent UAE with TAGM alone. Univariate and multivariate analyses were performed to assess the relationships between the volume of TAGM and baseline parameters. Technical outcomes, tumor infarction on post-procedural contrast-enhanced MRI, and complications were evaluated.

Results: Technical success was achieved in all patients. Infarction of ≥90% of the total leiomyoma volume was observed in 93% (67/72) of patients. No major complications were noted. The mean (SD) volume of 500- to 700-μm particles used in all (73/73) patients was 10.3?±?4.6?ml. The multivariate analysis revealed that uterine volume (p?=?.034) correlated with the 500- to 700-μm TAGM volume. Seven hundred- to 900-μm particles were added for 70% (51/73) of patients at a mean (SD) volume of 3.6?±?4.6?ml. The dominant tumor volume (p?=?.028) correlated with the 700- to 900-μm TAGM volume.

Conclusion: The dominant tumor or uterine volume on pre-procedural MRI was directly associated with the volume of TAGM required for embolization of leiomyomas.     

Psychometric properties of field-based anaerobic capacity tests in children with Developmental Coordination Disorder

Background: Assessment of anaerobic capacity in children with Developmental Coordination Disorder (DCD) is essential for treatment planning. However, available field-based measures have no established validity and reliability in this population.

Purpose: To examine the psychometric properties of selected field-based anaerobic capacity tests in children with and without DCD.

Methods: School-aged children (6–16 years) with and without DCD participated in the study. The children completed the shuttle run sub-item of the Bruninks-Oseretsky test of motor proficiency-second edition, the 10?×?5 m sprint tests (straight and slalom) and the muscle power sprint test (MPST).

Results: The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and 10?×?5?m sprint tests possess good construct validity and test–retest reliability in children with DCD. The 10?×?5?m sprint test-slalom was found to be the most responsive test among children with DCD. However, the MPST was less reliable in children with DCD compared to their typically developing peers, leading to a very large Smallest Detectable Difference.

Conclusions: The findings suggest that the selected anaerobic capacity measures have sound psychometric properties among children with DCD with the exception of the MPST. Clinicians working on children with DCD could use these tests in their practice, especially in situations where logistical resources are limited.

• Implications for Rehabilitation

• Field-based anaerobic capacity tests are suitable measures for assessing anaerobic capacity in children with Developmental Coordination Disorder, particularly in situations where laboratory assessments are not feasible.

• The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and the 10?×?5 sprint tests (straight and slalom) have good construct validity in this population.

• The 10?×?5 sprint test (slalom) is the most sensitive anaerobic capacity test among children with Developmental Coordination Disorder.

     

A Novel Infant Chest Compression Assist Device Using a Palm Rather Than Fingers: A Randomized Crossover Trial

Objective: We developed a novel compression assist device (palm presser) to perform chest compressions using a palm in infant cardiopulmonary resuscitation (CPR). We hypothesized that the palm presser will increase compression depth without increasing hands-off time and will reduce rescuer fatigue compared with the two-finger technique (TFT).

Methods: In this randomized crossover manikin trial, participants performed two minutes of CPR with a 30:2 compression:ventilation ratio using the palm presser and the TFT in randomized sequence on an infant manikin. CPR parameters, including compression depth and hands-off time, were collected to compare CPR quality between the palm presser and the TFT. The linear mixed-effect model was used to control the carryover effect of a crossover design in the analysis of CPR parameters. To evaluate rescuer fatigue, we compared changes in compression depth over time and calculated the odds of sufficiently deep compressions over time between the two groups.

Results: The palm presser resulted in greater mean compression depth (41.5?±?1.6?mm vs. 36.8?±?5.5?mm, p?<?0.001), greater sufficiently deep compressions (80.9?±?27.8% vs. 42.4?±?35.4%, p?<?0.001), and better correct hand position (99.9?±?0.5% vs. 83.9?±?25.3%, p?=?0.013) than the TFT. Total compressions, compression rate, total ventilations, volume of ventilations, and hands-off time were not significantly different between the two groups. The mean change in compression depth over time was greater with the TFT than with the palm presser (regression coefficient: ?0.024 [95% CI ?0.030 to ?0.018] vs. ?0.004 [95% CI ?0.006 to ?0.002]). The odds of a compression depth greater than 40?mm increased 2.8 times (95% CI 2.2 to 3.4) with the TFT during the first minute compared with the last minute, whereas the corresponding odds ratio when using the palm presser was not significantly different in the first and last minutes (OR: 1.2 [95% CI 0.9 to 1.5]).

Conclusions: Compression with palm pressers resulted in greater compression depth without increasing hands-off time and reduced rescuer fatigue compared with compression with the TFT in simulated infant CPR with manikins.     

The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial

Study Design: Randomized clinical trial with pre-test, post-test control group design.

Objectives: To examine the immediate effects of cervical spinal manipulation (CSM) on serum concentration of biochemical markers (oxytocin, neurotensin, orexin A, and cortisol).

Background: Several studies have found an association between spinal manipulation (SM) and pain perception. However, the mechanism by which SM modulates pain remains undefined.

Methods: Twenty-eight female subjects with non-specific mechanical neck pain were randomly assigned to one of two interventions (CSM versus sham CSM). Blood samples were drawn before and immediately after the respective interventions. Oxytocin, neurotensin, orexin A, and cortisol were measured from the blood and serum using the Milliplex Map Magnetic Bead Panel Immunoassay on the Luminex 200 Platform.

Results: In the CSM group, there were significant increases in pre- versus post-manipulation mean oxytocin (154.5 ± 60.1 vs. 185.1 ± 75.6, p = .012); neurotensin (116.0 ± 26.5 vs.136.4 ± 34.1, p < . 001); orexin A (52.2 ± 31.1 vs. 73.8 ± 38.8, p < .01) serum concentration; but no significant differences in mean cortisol (p = .052) serum concentration. In the sham group, there were no significant differences in any of the biomarkers (p > .05).

Conclusion: The results of the current study suggest that the mechanical stimuli provided through a CSM may modify neuropeptide expression by immediately increasing the serum concentration of nociception-related biomarkers (oxytocin, neurotensin, orexin A, but not cortisol) in the blood of female subjects with non-specific mechanical neck pain.     

Endovascular management of endotension by graft reinforcement followed by direct sac embolization

Purpose: To assess the efficacy of graft reinforcement followed by percutaneous direct sac embolization (PDSE) for the treatment of endotension after endovascular abdominal aortic aneurysm repair (EVAR).

Materials and methods: A total of 290 patients underwent elective EVAR. All patients regularly underwent scheduled surveillance with contrast-enhanced computed tomography (CT). Two hundred thirty-five patients were followed for ≥24?months after EVAR. Aneurysmal sac expansion of ≥10?mm was observed in 20 patients. The patients with sac expansion of ≥10?mm with no evidence of endoleak were treated with graft reinforcement. Graft reinforcement consisted of graft extension and graft relining. The patients with sac expansion at 6?months after graft reinforcement received PDSE using metallic coils and n-butyl cyanoacrylate–Lipiodol mixture. The aneurysm diameter was measured by CT performed 6?months and every year after the final intervention.

Results: Seven patients (7 men, 0 women; mean age, 69.1?±?4.2?years, Zenith^®:5/Excluder^®:1/Powerlink^®:1) underwent graft reinforcement. Two patients underwent graft reinforcement alone, and five patients underwent PDSE after graft reinforcement. Mean follow-up time after the final intervention was 21.1?months. The sac diameter stabilized after the final intervention in all patients.

Conclusion: Graft reinforcement followed by complementary PDSE could be a useful treatment strategy for endotension.     

An electromagnetic tracking needle clip: an enabling design for low-cost image-guided therapy

Introduction: In this study, we hypothesized a disposable low-cost needle clip with a specially designed electromagnetic (EM) tracking sensor. It could be mounted onto 16- to 22-gauge needles, allowing the tip of the needle to be tracked in CT or US image-guided procedures using the Aurora EM tracking system.

Material and methods: A 3?D printed EM needle clip case contains a pair of specially designed electromagnetic solenoids, positioned perpendicularly to each other in order to achieve six degrees of freedom for tracking the tip of the needle. The performance of the EM tracking needle clip was evaluated.

Results: A low-cost 3D-printed disposable needle clip with specially designed EM tracking sensors that can be mounted on 16- to 22-gauge needles was designed. This needle clip has a 570?mm ×600?mm ×600?mm (L?×?W?×?H) working volume, an error <0.7?mm in the axial direction and 0.8?mm in the radial direction. The targeting accuracy results are on par with the commercially available EM tracking needles.

Conclusion: The designed EM needle clip provided successful needle tracking, with acceptable accuracy, and competitive performance compared to existing products. This proposed design may increase the clinical adoption of EM tracking needles because of its user-friendly design and low cost.     

Body composition and its association with physical performance,quality of life,and clinical indictors in Charcot-Marie-Tooth disease: a pilot study

Aim: To investigate whether the amount and distribution of lean body mass and fat mass is associated with disease severity in adults with Charcot-Marie Tooth.

Methods: Ten participants (age 46?±?13?y, height 1.7?±?0.1?m, and body mass 77?±?17?kg) with Charcot-Marie Tooth disease were involved in this study. Participants were evaluated for quality of life, falls efficacy, balance, mobility, muscle strength, and power. Body composition was measured using dual energy x-ray absorptiometry. Statistical analyses were conducted on subsets of all participants.

Results: Better static balance was associated with higher lean body mass of the lower leg (r?=?0.73, p?=?0.03), while superior leg press strength and power was associated with greater lean body mass of the leg and lower leg (r?≥?0.80, p?≤?0.01). Faster habitual walking speed and enhanced quality of life was associated with lower fat mass of several regions.

Conclusion: Our study seems to suggest that assessing of body composition could assist with monitoring of disease progression in people with Charcot-Marie Tooth; however these findings need to be substantiated in a larger cohort.

• Implications for Rehabilitation

• Higher lean body mass and lower fat mass of the legs is associated with better physical performances in people with Charcot-Marie-Tooth disease.

• Lower fat mass is related to greater quality of life and reduced clinical symptoms in people with Charcot-Marie-Tooth disease.

• Optimising favorable body composition profiles (higher lean body mass and lower fat mass) in people with Charcot-Marie-Tooth disease may be highly clinically relevant.

     

Visit patterns at primary care centres and individual blood pressure level – a cross-sectional study

Objective: Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control.

Design and setting: Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region.

Patients: A total of 88,945 patients with uncomplicated hypertension age 40–79.

Main outcome measures: Odds ratio (OR) for the individual patient to achieve the BP target of ≤140/90?mmHg.

Results: Overall, 63% of patients had BP?≤?140/90?mmHg (48% BP?<?140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32).

Conclusions: In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.     

The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis

Purpose: The purpose of this thematic synthesis review was to identify and synthesise published qualitative research on the perspectives of individuals with spinal cord injuries with respect to physical rehabilitation interventions.

Materials and methods: The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies.

Results: In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean?±?standard deviation?=?14.39?±?3.61). The four main themes developed were: (1) Benefits of physical rehabilitation, (2) Challenges of physical rehabilitation, (3) Need for support, and (4) Issue of control.

Conclusions: This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care.

• Implications for Rehabilitation

• Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance.

• Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care.

• People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries.

• There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.

     

One-stage posterior approach for treating multilevel noncontiguous thoracic and lumbar spinal tuberculosis

Objectives: Multilevel noncontiguous thoracic and lumbar spinal tuberculosis (MNST) is a relatively rare entity. The objective of this retrospective study was to investigate whether a technique involving a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumentation, is effective for treating MNST.

Methods: Thirteen patients, with an average age of 40.69 (18–67) years, who had MNST and were surgically treated in our department from January 2008 to October 2013, were reviewed.

Results: The average follow-up time was 37.54 ± 10.49 (19–58) months. The mean Cobb angle range was 15.69° ± 00A09.09° (?3° to 33°). The mean erythrocyte sedimentation rate (ESR) was 47.69 ± 9.30 mm/h (range 30–62 mm/h) before the operation. Neurological deficits were evaluated using the Frankel grade system. The mean Cobb angle decreased to 6.92° ± 3.93° postoperatively. Three months after the operation, the Cobb angle was 7.54° ± 4.35°, and the average ESR was 10.38 ± 4.54 mm/h that was normal for all cases in this retrospective observational study. Solid fusion was achieved in all cases. No severe complications occurred.

Conclusions: The study demonstrated that a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumentation, was effective for treating MNST.     

Prostate shape significantly affects the HoLEP procedure time and energy usage: A retrospective pilot study

Introduction: In this study we evaluate the influence of longitudinal and transverse length of prostate size measured on the magnetic resonance imaging (MRI) scan on the overall outcomes of HoLEP.

Material and methods: The patients were divided into two groups based on the shape of the prostate. Group 1 had a longitudinal shape with a longitudinal diameter greater than the transverse diameter, whereas group 2 had an oval shape with a transverse diameter greater than the longitudinal diameter. The pre-operative, peri-operative and the one-month post-operative data along with the urinary parameters were then evaluated.

Results: The two groups were comparable with regard to their pre-operative values. While the median lobe enucleation time and morcellation time showed no difference, group 1 showed a significantly shorter (p?<?0.01) operative time for lateral lobe enucleation, lower laser energy usage and better enucleation efficiency. However, there was no difference in the median lobe enucleation time, morcellation time, haemoglobin drop, duration of urethral catheterization and hospital stay. The groups were also comparable with regard to the improvement in urinary parameters and complications.

Conclusion: Prostate shape plays a significant role in the surgical treatment of BPH.     

Immediate improvements of supination range of motion and strength following pronator teres muscle friction massage: a clinical trial comparing people with and without supination limited motion

Objectives: To investigate the effects of friction massage techniques on the pronator teres muscle on supination range of motion (ROM) and supinator strength in individuals with and without limited supination ROM.

Methods: In total, 26 subjects (13 with limited supination ROM and 13 healthy subjects) volunteered to participate in this study. We used a customized wrist cuff. Supination ROM and supinator strength were measured with a 9-axis inertial motion sensor and load cell. The friction massage protocol was executed with the pronator teres muscle in a relaxed position. Then supination ROM and supinator strength were measured again.

Results: There was no significant interaction effect on supination ROM, which was significantly greater in the limited supination and control groups. A post hoc t-test revealed that the limited supination group achieved a significantly increased post-test supination ROM (51.7 ± 7.8°) compared to the pre-test value (43.6 ± 5.2°). In addition, the control group achieved a significant increase in post-test supination ROM (67.7 ± 10.0°) compared to the pre-test value (61.4 ± 7.7°). There was no significant interaction effect on supinator strength. Supinator strength was significantly greater in the limited supination and control groups. A post hoc t-test revealed a significant difference in supinator strength between the pre- and post-test values in the limited supination group.

Discussion: Friction massage helps restore a limited ROM of the forearm supination motion and immediately increases supinator muscle strength. This technique can be used as an intervention method to improve muscle strength in patients with limited supination ROM.     

Effectiveness and safety of secukinumab in Italian patients with psoriasis: an 84 week,multicenter, retrospective real-world study

Background: Long term data on the real-life use of secukinumab are scant. The aim of this study was to investigate the real-life effectiveness, safety and treatment persistence of secukinumab in patients with moderate-to-severe psoriasis.

Research design and methods: This 84-week, multicenter (n = 7) retrospective study analyzed data from patients who initiated and received at least 6 months of secukinumab treatment between June 2016 and June 2018 in the Campania region of Italy. Patient demographic and treatment characteristics, duration of treatment and reasons for discontinuation as well as Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores were assessed.

Results: 324 patients (63% male, mean age 50.2 years) were enrolled and received a mean 11.7 months of secukinumab treatment. Overall, 9.5% discontinued secukinumab, including 5.2% who discontinued due to secondary inefficacy and 1.8% due to adverse events. PASI, BSA and DLQI scores were significantly improved from baseline at every follow-up visit (p < 0.001) and mean PASI decreased from 15.3 ± 6.3 at baseline to 0.5 ± 1.0 at week 84. Secukinumab had comparable effectiveness in biologic naïve and non-naïve patients.

Conclusions: This study confirmed the effectiveness and safety of secukinumab in real-world patients with psoriasis.     

Medication adherence,biological and lifestyle risk factors in patients with myocardial infarction: a ten-year follow-up on socially differentiated cardiac rehabilitation

Objective: There is strong evidence that medication adherence and lifestyle changes are essential in patients undergoing secondary cardiovascular disease prevention. Cardiac rehabilitation (CR) increases medication adherence and improves lifestyle changes. Patients with cardiac diseases and a low educational level and patients with little social support are less responsive to improve medication adherence and to adapt lifestyle changes. The aim of the present study was to investigate the long-term effects of a socially differentiated CR intervention on medication adherence as well as changes in biological and lifestyle risk factors at two- five- and ten-year follow-up.

Design: A prospective cohort study.

Setting: The cardiac ward at Aarhus University Hospital, Denmark.

Intervention: A socially differentiated CR intervention in addition to the standard CR program.

Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N?=?379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network.

Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status.

Results: No significant long-term effect of the intervention was found.

Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.

• Key points

• The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors.

• Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking.

• General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.