Suboptimal Secondary Prevention Post Acute Coronary Syndromes: Insights from the SMART-REHAB Trial

Abstract

Introduction: International guidelines clearly state optimal secondary prevention with targets for blood pressure, cholesterol and diabetes as well as optimal medical therapy and smoking cessation. It is uncertain how many of these targets are met post acute coronary syndromes (ACS). Methods: SMART-REHAB was a randomised controlled trial assessing the impact of a smartphone-based cardiac rehabilitation programme post ACS. Patients were recruited from 6 major tertiary hospitals in Victoria. We assessed the proportion of patients receiving optimal medical therapy (dual antiplatelet therapy, statin, beta-blocker, ACE inhibition) and those not achieving target BP (<130/80 mmHg), cholesterol (total cholesterol <4 mmol/L and LDL-C <1.8 mmol/L) or diabetic control (HbA1c < 7%) as well as those continuing to smoke at 8-week post ACS. Results: 168 patients were included (mean age 56 ± 10 years, 57% STEMI). At 8-weeks, the majority of patients were receiving aspirin (99%), a second anti-platelet agent (99%) and statin therapy (98%). The rate of beta-blocker (82%) and ACE/ARB (83%) use was lower. Suboptimal secondary prevention was evident, as seen below, but was not improved with smartphone technology.Tabled 1SmartphoneUsual Carep-valueTC >1.8mmol/L24%21%0.42LDL-C >1.8mmol/L38%45%0.42BP >130/80mmHg24%74%0.93HbA1C > 7%8%6%0.52Current Smokers15%15%0.76 Open table in a new tab Conclusion: A significant proportion of patients are not meeting secondary prevention targets, particularly for blood pressure, cholesterol and smoking, despite the use of smartphone technology. An updated approach with the use artificial intelligence and mhealth can be used to up-titrate medication to meet secondary prevention targets.