AIM: Long-term secondary prevention program may reduce CV risks after MI

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A secondary prevention program lasting up to three years after cardiac rehabilitation appears to reduce the risk of a second non-fatal heart attack and other cardiovascular events, according to a study in the Nov. 10 issue of Archives of Internal Medicine.

Rehabilitation includes helping patients with smoking cessation, diet, risk factors, and lifestyle habits. However, the authors wrote that current rehabilitation procedures rely on short-term interventions that are unlikely to yield long-term benefits because patients never reach therapeutic goals.

Pantaleo Giannuzzi, MD, of the Associazione Nazionale Medici Cardiologi Ospedalieri Research Center in Florence, Italy, and colleagues conducted the GOSPEL (GlObal Secondary Prevention StrategiEs to Limit event recurrence after MI) study, in which they randomly assigned 1,620 patients who had a heart attack to receive a long-term, reinforced, multi-factorial educational and behavioral intervention after a standard period of rehabilitation.

“The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines,” the authors wrote.

Comprehensive sessions with one-on-one support were held monthly for six months, then once every six months for three years, according to the researchers. Researchers compared the results of patients in the program with those of 1,621, who were randomly assigned to receive usual care.

Overall, Giannuzzi and colleagues reported that 17.2 percent experienced a CV event. The intervention did not significantly reduce the risk of combined heart events (which occurred in 16.1 percent of patients in the intervention group and 18.2 percent in the standard-care group), including CV death, non-fatal MI, non-fatal stroke and hospitalization for chest pain, heart failure or an urgent revascularization procedure to restore blood flow.

However, the authors wrote that the program significantly decreased incidence of individual heart events and some combinations of outcomes, including a 33 percent reduction in CV death plus non-fatal heart attack and stroke (3.2 percent in the intervention group vs. 4.8 percent in the standard-care group), a 36 percent reduction in cardiac death plus non-fatal MI (2.5 percent vs. 4 percent) and a 48 percent reduction in non-fatal MI (1.4 percent vs. 2.7 percent).

“A marked improvement in lifestyle habits (i.e., exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group,” the authors wrote.

“After three years, the integrated, multifactorial, reinforced approach proved effective in countering the risk factors and medication adherence deterioration over time and was able to induce a considerable improvement in lifestyle habits,” the authors concluded. “In line with such results, all the clinical end points were reduced by the intensive intervention.” The results reinforce previous findings that gains achieved with short-term cardiac rehabilitation are not maintained over time and suggest that a more comprehensive, sustained intervention is needed to reduce cardiovascular risks after a heart attack.