en
Scientific article
Open access
English

Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention

Published inPloS one, vol. 14, no. 2, e0211464
Publication date2019
First online date2019-02-21
Abstract

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.

eng
Keywords
  • Acute Coronary Syndrome / physiopathology
  • Acute Coronary Syndrome / rehabilitation
  • Acute Coronary Syndrome / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / prevention & control
  • Cohort Studies
  • Humans
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Secondary Prevention / methods
  • Switzerland
Citation (ISO format)
CARBALLO, David Andrés et al. Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention. In: PloS one, 2019, vol. 14, n° 2, p. e0211464. doi: 10.1371/journal.pone.0211464
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Article (Published version)
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Identifiers
ISSN of the journal1932-6203
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