Specialist-led community-based cardio-kidney-metabolic-pulmonary care in high-risk individuals: multi-centre pragmatic prospective randomized open-label blinded endpoint trial
In brief
Community specialist visits tripled guideline-directed treatment in high-risk adults
At 6 months, 62% of adults offered two community visits with a cardiology specialist had a medication started or increased for cardiovascular, kidney, metabolic, or pulmonary risk, versus 23% with usual care. The trial shows specialist review can close treatment gaps, but it measured prescribing changes, not whether these changes prevent heart attacks or other clinical events.
- Journal
- European heart journal open (Q1)
- Published
- 7 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ramesh Nadarajah, Ali Wahab, Ben Hurdus, Carl Simela, Tobin Joseph, Catherine Reynolds, et al.
- PMID
- 42948328
- DOI
- 10.1093/ehjopen/oeag169
Why clinicians should know about it
- Picked for Family Practice (paper of the day, 30 October 2026): Pragmatic primary-care RCT improves community chronic-disease treatment uptake
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.