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Observational Study
. 2019 Feb 21;14(2):e0211464.
doi: 10.1371/journal.pone.0211464. eCollection 2019.

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

David Carballo  1 , Nicolas Rodondi  2   3 , Reto Auer  3   4 , Sebastian Carballo  5 , David Nanchen  4 , Lorenz Räber  6 , Roland Klingenberg  7 , Pierre-Frédéric Keller  1 , Dik Heg  8 , Peter Jüni  9 , Olivier Muller  10 , Christian M Matter  7 , Thomas F Lüscher  7 , Stephan Windecker  6 , Francois Mach  1 , Baris Gencer  1
Affiliations
Observational Study

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

David Carballo et al. PLoS One. .

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.

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Conflict of interest statement

P.J. is an unpaid steering committee or statistical executive committee member of trials funded by Abbott Vascular, Biosensors, Medtronic, and St Jude Medical. R.K received lecture fees from Eli Lilly, Servier, and Bayer. T.F.L reports receiving research grants to the institution from Abbot, Biosensors, Biotronik, Boston Scientific, Daichi Sankyo, Eli Lilly and Medtronic, and consultant payments from AstraZeneca, Boehringer Ingelheim, Bayer, Merck, and Pfizer, MSD, Roche, and Servier. C.M.M. reports receiving grants from MSD, AstraZeneca, and Roche, and having patents from Mabimmune, CH. S.W. reports receiving research contracts to the institution from Abbott, Biotronik, Boston Scientific, Biosensors, Cordis, Medtronic, St Jude Medical, and speaker fees from Abbott, Biotronik, Boston Scientific, Biosensors, Medtronic, Eli Lilly, and AstraZeneca. F.M. has received research grants to the institution from Amgen, AstraZeneca, Eli Lilly, MSD, Novartis, Sanofi, and Pfizer, including speaker of consultant fees. Other authors did not report conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flowchart of the studied cohort.
Fig 2
Fig 2. Cumulative hazards for the composite endpoints of cardiac death, myocardial infarction and stroke events over a follow-up period of 365 days in the standard care vs. the ELIPS add-on groups (logrank, P = 0.26).
Abbreviations; MI, myocardial infarction.
Fig 3
Fig 3. One-year incidence of the composite endpoints of cardiac death, myocardial infarction and stroke events in the standard care vs. the ELIPS add-on groups according to baseline characteristics.
Abbreviations: ACS, acute coronary syndromes; CI, confidence intervals; STE-ACS, ST-elevation acute coronary syndromes; NSTE-ACS, non ST-elevation acute coronary syndromes.
See this image and copyright information in PMC

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