Specialist-led community-based cardio-kidney-metabolic-pulmonary care in high-risk individuals: multi-centre pragmatic prospective randomized open-label blinded endpoint trial.
5 affiliations
- 1Leeds Institute of Data Analytics, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK.
- 2Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK.
- 3Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
- 4Oral Clinical Research Unit, Faculty of Dentistry Oral Craniofacial Sciences, King's College London, London, UK.
- 5Wolfson Institute of Population Health, Queen Mary, University of London, UK.
Abstract
Aims
Pharmacological therapies that treat cardiovascular, kidney, metabolic, and pulmonary (CKMP) risk factors reduce the risk of major adverse cardiovascular events, but community-dwelling individuals may not receive all treatments to which they are eligible from non-specialists. This trial investigated if specialist-led care in the community increases the utilization of CKMP pharmacological interventions compared with usual care.Methods and results
This pragmatic prospective randomized open-label blinded endpoint trial included community-dwelling high-risk adults aged ≥30 years from 15 primary care sites in England. Participants were randomized 1:1 to an intervention of two clinic appointments (at baseline and ∼3 months) with a cardiology specialist at their primary care site to review and optimize CKMP risk factors in accordance with UK guidelines, or usual care. The primary outcome was the proportion of participants with initiation and/or increase in the dose of guideline-directed CKMP pharmacological therapies at 6 months after date of randomization. Between March 2025 and July 2025, 138 participants were randomized (68 intervention, 70 control); the median age was 76.6 years, and 52.9% were women. At 6 months after randomization, in the intervention arm, 42 of 68 (61.8%) patients received a CKMP pharmacological intervention compared with 16 of 70 patients (22.9%) in the control arm (odds ratio 5.4, 95% CI 2.5-12.3, P < 0.0001, absolute risk difference 38.9%, 95% CI 23.7-54.1%).Conclusion
Specialist-led care in the community for high-risk individuals increased the use of pharmacological interventions for CKMP risk factors compared to usual care.
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BibTeX
@article{nadarajah2026specialistled,
title = {{Specialist-led community-based cardio-kidney-metabolic-pulmonary care in high-risk individuals: multi-centre pragmatic prospective randomized open-label blinded endpoint trial.}},
author = {Ramesh Nadarajah and Ali Wahab and Ben Hurdus and Carl Simela and Tobin Joseph and Catherine Reynolds and Sheena Bennet and Mohammad Haris and Louise Clark and Chris Hayward and Jing Kang and Jianhua Wu and Chris P Gale},
journal = {European heart journal open},
year = {2026},
month = sep,
doi = {10.1093/ehjopen/oeag169},
url = {https://europepmc.org/article/MED/42948328},
note = {CC BY},
}
RIS
TY - JOUR
TI - Specialist-led community-based cardio-kidney-metabolic-pulmonary care in high-risk individuals: multi-centre pragmatic prospective randomized open-label blinded endpoint trial.
AU - Ramesh Nadarajah
AU - Ali Wahab
AU - Ben Hurdus
AU - Carl Simela
AU - Tobin Joseph
AU - Catherine Reynolds
AU - Sheena Bennet
AU - Mohammad Haris
AU - Louise Clark
AU - Chris Hayward
AU - Jing Kang
AU - Jianhua Wu
AU - Chris P Gale
PY - 2026
DA - 2026/09/01
JO - European heart journal open
DO - 10.1093/ehjopen/oeag169
UR - https://europepmc.org/article/MED/42948328
AB - Aims Pharmacological therapies that treat cardiovascular, kidney, metabolic, and pulmonary (CKMP) risk factors reduce the risk of major adverse cardiovascular events, but community-dwelling individuals may not receive all treatments to which they are eligible from non-specialists. This trial investigated if specialist-led care in the community increases the utilization of CKMP pharmacological interventions compared with usual care.Methods and results This pragmatic prospective randomized open-label blinded endpoint trial included community-dwelling high-risk adults aged ≥30 years from 15 primary care sites in England. Participants were randomized 1:1 to an intervention of two clinic appointments (at baseline and ∼3 months) with a cardiology specialist at their primary care site to review and optimize CKMP risk factors in accordance with UK guidelines, or usual care. The primary outcome was the proportion of participants with initiation and/or increase in the dose of guideline-directed CKMP pharmacological therapies at 6 months after date of randomization. Between March 2025 and July 2025, 138 participants were randomized (68 intervention, 70 control); the median age was 76.6 years, and 52.9% were women. At 6 months after randomization, in the intervention arm, 42 of 68 (61.8%) patients received a CKMP pharmacological intervention compared with 16 of 70 patients (22.9%) in the control arm (odds ratio 5.4, 95% CI 2.5-12.3, P < 0.0001, absolute risk difference 38.9%, 95% CI 23.7-54.1%).Conclusion Specialist-led care in the community for high-risk individuals increased the use of pharmacological interventions for CKMP risk factors compared to usual care.
SN - 2752-4191
ER -