Cargando…

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

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 out...

Descripción completa

Detalles Bibliográficos
Autores principales: Carballo, David, Rodondi, Nicolas, Auer, Reto, Carballo, Sebastian, Nanchen, David, Räber, Lorenz, Klingenberg, Roland, Keller, Pierre-Frédéric, Heg, Dik, Jüni, Peter, Muller, Olivier, Matter, Christian M., Lüscher, Thomas F., Windecker, Stephan, Mach, Francois, Gencer, Baris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383891/
https://www.ncbi.nlm.nih.gov/pubmed/30789921
http://dx.doi.org/10.1371/journal.pone.0211464
_version_ 1783396912656809984
author Carballo, David
Rodondi, Nicolas
Auer, Reto
Carballo, Sebastian
Nanchen, David
Räber, Lorenz
Klingenberg, Roland
Keller, Pierre-Frédéric
Heg, Dik
Jüni, Peter
Muller, Olivier
Matter, Christian M.
Lüscher, Thomas F.
Windecker, Stephan
Mach, Francois
Gencer, Baris
author_facet Carballo, David
Rodondi, Nicolas
Auer, Reto
Carballo, Sebastian
Nanchen, David
Räber, Lorenz
Klingenberg, Roland
Keller, Pierre-Frédéric
Heg, Dik
Jüni, Peter
Muller, Olivier
Matter, Christian M.
Lüscher, Thomas F.
Windecker, Stephan
Mach, Francois
Gencer, Baris
author_sort Carballo, David
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6383891
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-63838912019-03-09 Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention Carballo, David Rodondi, Nicolas Auer, Reto Carballo, Sebastian Nanchen, David Räber, Lorenz Klingenberg, Roland Keller, Pierre-Frédéric Heg, Dik Jüni, Peter Muller, Olivier Matter, Christian M. Lüscher, Thomas F. Windecker, Stephan Mach, Francois Gencer, Baris PLoS One Research Article 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. Public Library of Science 2019-02-21 /pmc/articles/PMC6383891/ /pubmed/30789921 http://dx.doi.org/10.1371/journal.pone.0211464 Text en © 2019 Carballo et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Carballo, David
Rodondi, Nicolas
Auer, Reto
Carballo, Sebastian
Nanchen, David
Räber, Lorenz
Klingenberg, Roland
Keller, Pierre-Frédéric
Heg, Dik
Jüni, Peter
Muller, Olivier
Matter, Christian M.
Lüscher, Thomas F.
Windecker, Stephan
Mach, Francois
Gencer, Baris
Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title_full Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title_fullStr Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title_full_unstemmed Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title_short Clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: A prospective multicenter healthcare intervention
title_sort clinical impact of a structured secondary cardiovascular prevention program following acute coronary syndromes: a prospective multicenter healthcare intervention
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383891/
https://www.ncbi.nlm.nih.gov/pubmed/30789921
http://dx.doi.org/10.1371/journal.pone.0211464
work_keys_str_mv AT carballodavid clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT rodondinicolas clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT auerreto clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT carballosebastian clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT nanchendavid clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT raberlorenz clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT klingenbergroland clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT kellerpierrefrederic clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT hegdik clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT junipeter clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT mullerolivier clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT matterchristianm clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT luscherthomasf clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT windeckerstephan clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT machfrancois clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention
AT gencerbaris clinicalimpactofastructuredsecondarycardiovascularpreventionprogramfollowingacutecoronarysyndromesaprospectivemulticenterhealthcareintervention