Intensive Prevention Program Decreases Long-Term Risks After MI

A nonphysician intensive prevention program (IPP) for patients who had a myocardial infarction (MI) was effective at improving control of risk factors and reducing more serious clinical events. These findings were published in The American Journal of Cardiology.

All patients (N=275) hospitalized with acute ST-segment and non-ST-segment elevation MI at 2 centers in Germany were recruited for this study. After discharge and 3 weeks of acute cardiac rehabilitation, patients were randomly assigned in a 1:1 ratio to receive 12 months of IPP (n=136) or usual care (n=139).

The IPP intervention, coordinated by nonphysician “prevention assistants” supervised by cardiologists, comprised a group monthly education session, a personal telephone call every 3 weeks, clinical visits if needed, and telemetric devices to track physical activity. Clinical outcomes through a 24-month follow-up were assessed.

All patients were scored by the IPP prevention score, which awarded points for smoking status, low-density lipoprotein cholesterol (LDL-C) level, physical activity, blood pressure, body mass index (BMI), and hemoglobin A_1C for a maximum score (least risk) of 15 points.

At baseline, the intervention and control participant cohorts comprised 45% and 45% current smokers, with a mean low density lipoprotein (LDL-C) of 108±37 and 124±36 mg/dL, physical activity was median 0 (quartiles, 0-1232) and 0 (quartiles, 0-679) kcal/week, mean blood pressure was 128/77±19/11 and 129/78±17/11 mmHg, and BMI was 28.4±3.9 and 28.4±3.9, respectively.

The IPP intervention improved the IPP risk score from 10.4±2.1 to 11.6±2.2 points (P <.01) at 12 months. After the IPP termination, the score decreased to 10.9±2.3 points at 24 months but remained higher than that of the control group participants (9.2±2.3 points; P <.01). Among the usual care group, risk factors were observed to deteriorate throughout the study duration.

Mortality occurred among 1.5% of the IPP and 2.2% of the usual care cohorts. The composite endpoint of death, resuscitation, stroke, MI, revascularization, or hospitalization for unstable angina was 12.5% among the IPP cohort and 20.9% among the control group participants (P =.06).

The IPP intervention cost was €491 per patient over the 12-month program. Taking into account the cost of adverse events, after 24 months, €1070 was spent on each patient in the IPP and €1170 was spent per patient for usual care, indicating IPP intervention was a cost-saving program.

In a substudy, short reinterventions lasting 2 months that were carried out more than 24 months after MI, again by nonphysician “prevention assistants” supervised by cardiologists, further improved risk factor control, including physical activity and blood pressure, compared with those receiving no reintervention.

The findings in this study may not be generalizable to other patient populations.

The study authors concluded that a 12-month IPP program decreased MI-associated risk factors among patients and cost of serious events up to 24 months after MI.

Reference

Osteresch R, Fach A, Frielitz FS, et al. Long-term effects of an intensive prevention program after acute myocardial infarction. Am J Cardiol. Published online July 5, 2021. doi:10.1016/j.amjcard.2021.05.034