Effects of an intensive long-term prevention programme after myocardial infarction – a randomized trial

Wienbergen, Harm and Fach, Andreas and Meyer, Sven and Meyer, Jochen and Stehmeier, Janina and Backhaus, Tina and Michel, Stephan and Krämer, Kirsten and Osteresch, Rico and Schmucker, Johannes and Haase, Henning and Härle, Tobias and Elsässer, Albrecht and Hambrecht, Rainer
European Journal of Preventive Cardiology
BackgroundLong-term risk factor control after myocardial infarction (MI) is currently inadequate and there is an unmet need for effective secondary prevention programmes.Design and methodsIt was the aim of the study to compare a 12-month intensive prevention programme (IPP), coordinated by prevention assistants and including education sessions, telephone visits and telemetric risk factor control, with usual care after MI. Three hundred and ten patients were randomized to IPP vs. usual care one month after hospital discharge for MI in two German heart centres. Primary study endpoint was the IPP Prevention Score (0–15 points) quantifying global risk factor control.ResultsGlobal risk factor control was strongly improved directly after MI before the beginning of the randomized study (30increase IPP Prevention Score). During the 12-month course of the randomized trial the IPP Prevention Score was improved by a further 14.3in the IPP group (p 0.001), while it decreased by 11.8in the usual care group (p 0.001). IPP significantly reduced smoking, low-density lipoprotein cholesterol, systolic blood pressure and physical inactivity compared with usual care (p 0.05). Step counters with online documentation were used by the majority of patients (80Quality of life was significantly improved by IPP (p 0.05). The composite endpoint of adverse clinical events was slightly lower in the IPP group during 12 months (13.8vs. 18.9p = 0.25).ConclusionsA novel intensive prevention programme after MI, coordinated by prevention assistants and using personal teachings and telemetric strategies for 12 months, was significantly superior to usual care in providing sustainable risk factor control and better quality of life.