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Risk factor management program not superior to standard care after ACS
An education program for patients with a recent ACS was not associated with superior improvement in CV risk factors compared with standard care, according to results of the RESICARD PREVENTION study.
Researchers conducted the two-arm, parallel-group, multicenter, randomized study to evaluate the effectiveness of the House of Education lifestyle-related CV risk-factor education program.
Patients underwent the program in a non–hospital-based office that was led by a nurse trained in smoking cessation counseling, a dietitian trained in physical activity counseling and an administrative coordinator trained in individual consultations. There was also a telephone hotline available to provide more information about CV risk factors and education, according to the study.
Ariel Cohen, MD, and colleagues enrolled 502 patients from June 2006 to July 2008. All had been hospitalized in a cardiac ICU for ACS and had at least one of the following lifestyle risk factors at baseline: current smoking, fewer than 3 hours per week of exercise or BMI of at least 25. Half the patients were assigned to the House of Education program and half were assigned standard care. Those assigned the House of Education program received at least six consultations in person or by phone between the index event and 1 year after.
The primary outcome was a composite including at least one of the following at 1 year: smoking cessation, at least 3 hours per week of physical activity, a 5% reduction in weight or a 4% reduction in waist circumference.
At 1 year, there was no difference in the primary outcome between the House of Education group and the standard care group (51.8% success rate vs. 49.8% success rate; adjusted RR=1.11; 95% CI, 0.9-1.37.)
There was also no difference between the groups in correction of all risk factors (adjusted RR=1.22; 95% CI, 0.89-1.66), in meeting the goal for physical activity (adjusted RR=1.05; 95% CI, 0.92-1.21), in smoking cessation (adjusted RR=0.99; 95% CI, 0.87-1.13) or in meeting the goals for weight and waist reduction (adjusted RR=1.07; 95% CI, 0.84-1.36).
Adverse event rates between the groups during the study period were similar, including death (House of Education group, 2.9%; standard care group, 2.8%); arrhythmia (1.6% vs. 2.8%); coronary angiography (7.3% vs. 8.9%); scheduled angioplasty (4.9% vs. 3.2%); ACS, stent thrombosis or chest pain (13.5% vs. 12.6); and dyspnea, lung edema or congestive HF (3.7% vs. 2.4%).
“Our findings showed that modification of patient behavior is difficult and that, despite a specific education program, only about one-quarter of patients could correct all their [CV] risk factors,” Cohen, of Université Pierre et Marie Curie, Paris, and colleagues concluded.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.