Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
Windecker S., Mach F., Gencer B., Carballo D., Rodondi N., Auer R., Carballo S., Nanchen D., Räber L., Klingenberg R., Keller PF., Heg D., Jüni P., Muller O., Matter CM., Lüscher TF.
Background Structured secondary cardiovascular prevention programs (SSCP) following acute coronary syndromes (ACS) may reduce major adverse cardiovascular events (MACE) through better adherence to post-ACS recommendations. Methods Through a prospective multicenter cohort study, we compared the outcomes of two sequential post-ACS patient cohorts, the initial one receiving standard care (SC) followed by one receiving additional interventions (SSCP) aimed at improving patient education as well as healthcare provider and hospital systems. The primary endpoint was MACE at one year. Secondary endpoints included adherence to recommended therapies, attendance to cardiac rehabilitation (CR) and successful achievement of cardiovascular risk factor (CVRF) targets. Results In total, 2498 post-ACS patients from 4 Swiss university hospitals were included: 1210 vs 1288 in the SC and SSCP groups, respectively. The SSCP group demonstrated a significant increase in attendance to CR programs (RR 1.08, 95%CI 1.02–1.14, P = 0.006), despite not achieving the primary MACE endpoint (HR 0.97, 95%CI 0.77–1.22, P = 0.79). After age-stratification, significant reductions in cardiac death, MI and stroke events (HR 0.53, 95%CI 0.30–0.93, P for interaction = 0.016) were observed for SSCP patients 65 years old. The SSCP group also scored significantly better for the LDL cholesterol target (RR 1.07, 95%CI 1.02–1.13, P = 0.012), systolic blood pressure target (RR 1.06, 95%CI 1.01–1.13, P = 0.029) and physical activity (RR 1.10, 95%CI 1.01–1.20, P = 0.021). Conclusions The implementation of an SSCP post ACS was associated with an improvement in the control of CVRF and attendance to CR programs, and was also associated with significant reductions in cardiac death, MI and stroke at one year for patients 65years old.