In-hospital multidimensional secondary prevention interventions after acute coronary syndrome were associated with reduced 1-year all-cause mortality (RR 0.79; 95% CI 0.69-0.92).
Meta-Analysis (n=37,585)
Do in-hospital multidimensional secondary prevention interventions reduce all-cause mortality in patients after an acute coronary syndrome?
In-hospital multidimensional secondary prevention interventions after ACS show promising but not definitive reductions in mortality, as benefits are primarily seen in before-after studies rather than controlled trials.
Relative Risk: 0.79 (95% CI 0.69–0.92)
BACKGROUND: Secondary prevention programs for patients experiencing an acute coronary syndrome have been shown to be effective in the outpatient setting. The efficacy of in-hospital prevention interventions administered soon after acute cardiac events is unclear. We performed a systematic review and meta-analysis to determine whether in-hospital, patient-level interventions targeting multiple cardiovascular risk factors reduce all-cause mortality after an acute coronary syndrome. METHODS AND RESULTS: Using a prespecified search strategy, we included controlled clinical trials and before-after studies of secondary prevention interventions with at least a patient-level component (ie, education, counseling, or patient-specific order sets) initiated in hospital with outcomes of mortality, readmission, or reinfarction rates in acute coronary syndrome patients. We classified the interventions as patient-level interventions with or without associated healthcare provider-level interventions and/or system-level interventions. Twenty-six studies met our inclusion criteria. The summary estimate of 14 studies revealed a relative risk of all-cause mortality of 0.79 (95% CI, 0.69 to 0.92; n=37,585) at 1 year. However, the apparent benefit depended on study design and level of intervention. The before-after studies suggested reduced mortality (relative risk RR, 0.77; 95% CI, 0.66 to 0.90; n=3680 deaths), whereas the RR was 0.96 (95% CI, 0.64 to 1.44; n=99 deaths) among the controlled clinical trials. Only interventions including a provider- or system-level intervention suggested reduced mortality compared with patient-level-only interventions. CONCLUSIONS: The evidence for in-hospital, patient-level interventions for secondary prevention is promising but not definitive because only before-after studies suggest a significant reduction in mortality. Future research should formally test which components of interventions provide the greatest benefit.
Auer et al. (2008) conducted a meta-analysis in acute coronary syndrome (n=37,585). In-hospital, patient-level interventions for secondary prevention was evaluated on all-cause mortality (RR 0.79, 95% CI 0.69 to 0.92). In-hospital multidimensional secondary prevention interventions after acute coronary syndrome were associated with reduced 1-year all-cause mortality (RR 0.79; 95% CI 0.69-0.92).