A nurse-coordinated prevention program significantly reduced MACE compared to standard of care in post-ACS patients (16.2% vs 22.6%; HR 0.70; 95% CI 0.57-0.85; P<0.001).
RCT (n=2,057)
1:1
Yes
Does a nurse-coordinated prevention program reduce MACE in patients after an acute coronary syndrome compared to standard of care?
A nurse-coordinated secondary prevention program significantly reduces long-term major adverse cardiovascular events in patients following an acute coronary syndrome.
Effect estimate: HR 0.70 (95% CI 0.57-0.85)
Absolute Event Rate: 16.2% vs 22.6%
p-value: p=<0.001
BACKGROUND AND AIMS: There is a lack of long-term outcome data supporting the role of nurses in cardiovascular (CV) risk management. The ALLEPRE ALLiance for sEcondary PREvention after an acute coronary syndrome (ACS) trial was a pragmatic, randomized, multicentre, interventional trial comparing the efficacy of a nurse-coordinated prevention program (NCPP) with standard of care (SOC). METHODS: The NCPP patients attended nine individual educational sessions over four years at which a centrally trained nurse provided counselling aimed at identifying CV risk factors and encouraging healthier lifestyles and medication adherence; the SOC patients followed the standard practices of their hospitals. The trial's primary endpoint was the composite of CV death, non-fatal myocardial infarction (MI), and non-fatal stroke (MACE). RESULTS: A total of 2057 ACS patients were randomized 1:1 to the NCCP (n=1031) or SOC group (n=1026). In comparison with SOC, the NCPP significantly reduced MACE 16.2% vs 22.6%; hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.57-0.85; P-value <0.001, a benefit mainly driven by a reduction in non-fatal MI (9.3% vs 15.2%; HR 0.60; 95% CI 0.46-0.77; P-value=0.0001). The occurrence of the pre-specified secondary outcome of MACE plus ischaemia-driven revascularization was significantly reduced (HR 0.77, 95% CI 0.64-0.92; P-value= 0.005). Exercise frequency (P<0.0001), body weight control (P=0.003), and medication adherence (P<0.001) improved more in the NCPP group. CONCLUSIONS: The NCPP significantly reduced long-term MACE, improved physical activity, body weight control, and pharmacotherapy adherence in post-hospitalization ACS patients. Including an NCPP in healthcare provision may contribute to the successful implementation of secondary prevention strategies.
““The results of this trial are particularly relevant as an increasing number of ACS patients are living longer, and there is a growing need for innovative, [patient-centered] models that can counteract the fragmentation of [health care] services... including an NCPP in [health care] provision may...”
Magnani et al. (Mon,) conducted a rct in Acute coronary syndrome (n=2,057). Nurse-coordinated prevention program (NCPP) vs. Standard of care (SOC) was evaluated on Composite of CV death, non-fatal myocardial infarction (MI), and non-fatal stroke (MACE) (HR 0.70, 95% CI 0.57-0.85, p=<0.001). A nurse-coordinated prevention program significantly reduced MACE compared to standard of care in post-ACS patients (16.2% vs 22.6%; HR 0.70; 95% CI 0.57-0.85; P<0.001).