Nurse-led behavior changes after heart attack cut subsequent event risk by 30%
Key takeaways:
- A nurse-coordinated prevention program initiated in the hospital cut long-term risk for heart events in adults after acute coronary syndrome.
- Benefits emerged early and further accrued over time.
CHICAGO — A nurse-coordinated intensive intervention program emphasizing lifestyle and behavioral changes after ACS was associated with a 30% reduction in major adverse CV events for patients, primarily driven by a reduction in nonfatal MI.
ACS is the largest contributor to global CVD burden and real-world evidence suggests secondary CV prevention remains suboptimal, Giulia Magnani, MD, PhD, a cardiologist at Parma University Hospital in Italy, said during a presentation at the American College of Cardiology Scientific Session.
“The involvement of nurses in cardiovascular prevention programs has been previously tied to short-term results, but there is a lack of long-term data and measurable benefits,” Magnani said.
Researchers analyzed data from 2,057 patients hospitalized for ACS randomly assigned to the nurse-coordinated prevention program (n = 1,031) or standard care (n = 1,026). The median age of participants was 64 years; 22% were women; most had hypertension and dyslipidemia and 18% had a previous MI. At discharge, nearly all participants were prescribed aspirin, a P2Y12 inhibitor, an ACE inhibitor, beta-blocker and statin therapy. All participating nurses worked full time at the study centers and attended a centralized, in-person training course run by a multidisciplinary team of medical, nursing and psychology experts.
Patients assigned to the intervention attended one-on-one educational sessions before hospital discharge, and again after 1, 3, 6, 12, 18, 24, 36 and 48 months. First-level interventions included counseling with caregiver involvement aimed at identifying CV risk factors, encouraging healthier lifestyles and ensuring treatment adherence. Second-level interventions included nurse referrals to a multidisciplinary team for the optimal treatment of CV risk factors and psychological support.
The primary endpoint was a composite of CV death, nonfatal MI or nonfatal stroke at 5 years, with a maximum follow-up of 7 years. Secondary endpoints included a composite of the primary endpoint and MI-driven revascularization, the individual components of the primary endpoint and all-cause death. An independent clinical event committee adjudicated all events.
At follow-up, patients who attended the nurse-coordinated care sessions were 30% less likely to experience a primary endpoint event, with rates of 16.2% and 22.6% in the intervention and usual care arms, respectively (HR = 0.7; 95% CI, 0.57-0.85; P = .0004). The primary endpoint was driven by nonfatal MI (HR = 0.6; 95% CI, 0.46-0.77; P = .0001), and results were consistent across all subgroups.
There were several marked improvements in lifestyle factors for patients in the intervention arm, including a decrease in BMI (P = .003) and increases in physical exercise intensity (P < .0001) and medication adherence (P < .001).
“You can see that the curves diverged early and the benefits further accrued over time,” Magnani said during a press conference. “Also, the nurse-coordinated program was effective in reducing BMI, increased physical activity intensity and increased medication adherence.”
Discussing the ALLEPRE study findings, Laura Davidson, MD, MS, FACC, assistant professor of medicine at Northwestern University and a member of the ACC Interventional Council, highlighted the burden for patients hospitalized with ACS, who often struggle to learn about a lengthy list of recommended lifestyle and behavior changes while coping with the stress of receiving a serious medical diagnosis.
“ACS is a devastating diagnosis that happens very suddenly, warranting lifestyle changes at a very quick pace,” Davidson said. “It can be a lot for patients to take in while they are in the hospital, faced with making not only lifestyle but medication changes. It may be the first time they are prescribed multiple medications. This study is important because it shows that with proper training from different types of clinicians, we can help these patients from the beginning of this diagnosis, using secondary prevention to prevent events in the future.”
Magnani said a cost-effectiveness analysis will be needed before a nurse-coordinated prevention program can be deployed on a wider scale.
Perspective
Back to TopThese data are not surprising. This intervention is nurse-coordinated, but you could make the argument that it could be layperson-coordinated with the right degree of understanding about what we want to accomplish. A “high touch” intervention makes sense, especially for people at significant risk. This is a high-risk population, with ACS and significant past events.
If you look closely, every single primary endpoint favors high-touch, highly coordinated nursing care. We see improvements in lipid status, BMI and body weight, a decrease in overall smoking habits — and this was across the board, for men and women. That strategy here, a greater degree of communication and interaction with patients after an event, is clearly helpful. In fact, it could be key.
The next step is to ask about the financial impact. That could be measured at least two ways. What was the investment in terms of training and preparing the nursing staff and what was the potential cost savings with this significant reduction in the overall event rate in the study population?
Associate Clinical Professor of Medicine
Yale School of Medicine
Adjunct Associate Professor of Medicine
Vanderbilt School of Medicine
Collapse
Magnani G, et al. Late-breaking clinical trials VI. Presented at: American College of Cardiology Scientific Session; March 29-31, 2025; Chicago (hybrid meeting).