Abstract
BackgroundSecondary prevention after acute coronary syndrome (ACS) could reduce morbidity and mortality, but guideline targets are seldom reached. We hypothesized that nurse-led telephone-based intervention would increase adherence.MethodsThe NAILED ACS trial is a prospective, controlled, randomized trial. Patients admitted for ACS at Östersund hospital, Sweden, were randomized to usual follow-up by a general practitioner or a nurse-led intervention. The intervention comprised telephone follow-up after 1 month and then yearly with lifestyle counselling and titration of medications until reaching target values for LDL-C (<2.5 mmol/L) and blood pressure (BP; <140/90 mmHg) or set targets were deemed unachievable. This is a 12-month exploratory analysis of the intervention.ResultsA total of 768 patients (396 intervention, 372 control) completed the 12-month follow-up. After titration at the 1-month follow-up, mean LDL-C was 0.38 mmol/L (95% CI 0.28 to 0.48, p<0.05), mean systolic BP 7 mmHg (95% CI 4.5 to 9.2, p<0.05), and mean diastolic BP 4 mmHg (95% CI 2.4 to 4.1, p<0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met by 94.1% and 91.9% of intervention patients and 68.4% and 65.6% of controls (p<0.05). At 12 months, mean LDL was 0.3 mmol/L (95% CI 0.1 to 0.4, p <0.05), systolic BP 1.5 mmHg (95% CI -1.0 to 4.1, p = 0.24), and mean diastolic BP 2.1 mmHg (95% CI 0.6 to 3.6, p <0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met in 77.7% and 68.9% of intervention patients and 63.2% and 63.7% of controls (p<0.05 and p = 0.125).ConclusionNurse-led telephone-based secondary prevention was significantly more efficient at improving LDL-C and diastolic BP levels than usual care. The effect of the intervention declined between 1 and 12 months. Further evaluation of the persistence to the intervention is needed.
Highlights
Even though morbidity and mortality after acute coronary syndrome (ACS) have improved significantly over the last few decades, cardiovascular disease (CVD) is still the most prominent cause of premature death worldwide
After titration at the 1-month follow-up, mean low-density lipoprotein cholesterol (LDL-C) was 0.38 mmol/L, mean systolic blood pressure (BP) 7 mmHg, and mean diastolic BP 4 mmHg lower in the intervention group
Target values for LDL-C and systolic BP were met by 94.1% and 91.9% of intervention patients and 68.4% and 65.6% of controls (p
Summary
Even though morbidity and mortality after acute coronary syndrome (ACS) have improved significantly over the last few decades, cardiovascular disease (CVD) is still the most prominent cause of premature death worldwide. Great advances have been achieved in the acute care of ACS, but a large part of the affliction in CVD is due to inadequate risk factor control to reduce future events [2]. Evidence-based guidelines for secondary preventive measures have been issued both nationally and internationally, and gradual improvements have been noted in the adherence to prescribed recommended medications in-hospital. Studies of the achievement of guideline targets after the transition from in-hospital to outpatient care have shown unsatisfactory fulfilment, despite a high prevalence of recommended medications [3], [4]. Secondary prevention after acute coronary syndrome (ACS) could reduce morbidity and mortality, but guideline targets are seldom reached. We hypothesized that nurse-led telephone-based intervention would increase adherence
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