Key result
A post-discharge educational intervention significantly increased the proportion of acute coronary syndrome patients achieving total cholesterol below 175 mg/dl (64.7% vs 56.5%, OR 1.46) at six months.
Why the study?
Does a post-discharge educational intervention with a signed patient-physician agreement improve the achievement of secondary prevention objectives in patients discharged after an acute coronary syndrome?
RCT (n=1,757)
Open-label
Stratified randomization by centre
Yes
Does a post-discharge educational intervention with a signed patient-physician agreement improve the achievement of secondary prevention objectives in patients discharged after an acute coronary syndrome?
Odds Ratio: 1.46 (95% CI 1.17–1.81)
Absolute Event Rate: 64.7% vs 56.5%
p-value: p=0.001
A simple post-discharge educational intervention involving a patient-physician agreement can modestly improve lifestyle modifications and lipid control at 6 months in patients following an acute coronary syndrome.
Supports post-discharge education with patient-physician agreements in ACS care; extends evidence for behavioral interventions improving secondary prevention targets.
OBJECTIVES: We investigated whether an intervention mainly consisting of a signed agreement between patient and physician on the objectives to be reached, improves reaching these secondary prevention objectives in modifiable cardiovascular risk factors six-months after discharge following an acute coronary syndrome. BACKGROUND: There is room to improve mid-term adherence to clinical guidelines' recommendations in coronary heart disease secondary prevention, specially non-pharmacological ones, often neglected. METHODS: In CAM-2, patients discharged after an acute coronary syndrome were randomly assigned to the intervention or the usual care group. The primary outcome was reaching therapeutic objectives in various secondary prevention variables: smoking, obesity, blood lipids, blood pressure control, exercise and taking of medication. RESULTS: 1757 patients were recruited in 64 hospitals and 1510 (762 in the intervention and 748 in the control group) attended the six-months follow-up visit. After adjustment for potentially important variables, there were, between the intervention and control group, differences in the mean reduction of body mass index (0.5 vs. 0.2; p < 0.001) and waist circumference (1.6 cm vs. 0.6 cm; p = 0.05), proportion of patients who exercise regularly and those with total cholesterol below 175 mg/dl (64.7% vs. 56.5%; p = 0.001). The reported intake of medications was high in both groups for all the drugs considered with no differences except for statins (98.1% vs. 95.9%; p = 0.029). CONCLUSIONS: At least in the short term, lifestyle changes among coronary heart disease patients are achievable by intensifying the responsibility of the patient himself by means of a simple and feasible intervention.
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Muñiz et al. (2010) conducted an RCT in Acute coronary syndrome (n=1,757). Post-discharge educational intervention (patient-physician agreement and reinforcement visit) vs. Usual care was evaluated on Total cholesterol < 175 mg/dl at 6 months (OR 1.46, 95% CI 1.17-1.81, p=0.001). A post-discharge educational intervention significantly increased the proportion of acute coronary syndrome patients achieving total cholesterol below 175 mg/dl (64.7% vs 56.5%, OR 1.46) at six months.
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