Nurse-coordinated care reduces long-term heart risks after acute coronary syndrome

Editor's Note

A nurse-coordinated prevention program significantly lowered the long-term risk of major adverse cardiovascular events (MACE) in adults recovering from acute coronary syndrome (ACS), according to an April 2 article in Healio. The program, which focused on lifestyle and behavioral changes, led to a 30% reduction in adverse events, primarily driven by a decrease in nonfatal myocardial infarction (MI). The positive effects emerged early and increased over time.

The program, presented at the American College of Cardiology Scientific Session, was developed in response to the ongoing challenge of secondary cardiovascular (CV) prevention in ACS patients. Giulia Magnani, MD, PhD, from Parma University Hospital in Italy, emphasized the need for long-term data, noting that previous studies linking nurse involvement in cardiovascular prevention had focused primarily on short-term outcomes.

To help close the gap, researchers analyzed data from 2,057 patients hospitalized for ACS, randomly assigning them to either the nurse-coordinated program (1,031 patients) or standard care (1,026 patients). The median age was 64, and 22% of participants were women. Most had hypertension and dyslipidemia, and 18% had a previous MI. At discharge, nearly all patients were prescribed aspirin, a P2Y12 inhibitor, an ACE inhibitor, a beta-blocker, and statin therapy.

The intervention involved one-on-one educational sessions before discharge and at multiple follow-up points (1, 3, 6, 12, 18, 24, 36, and 48 months). The first-level interventions focused on identifying CV risk factors, promoting healthier lifestyles, and encouraging medication adherence, often involving caregivers. Second-level interventions included nurse referrals to a multidisciplinary team for optimal risk factor management and psychological support.

The primary endpoint was a composite of CV death, nonfatal MI, or nonfatal stroke at five years, with a maximum follow-up of seven years. At follow-up, the rate of primary endpoint events was significantly lower in the intervention group (16.2%) compared to the usual care group (22.6%), with the reduction driven mainly by fewer nonfatal MIs. Patients in the nurse-coordinated program also saw improved lifestyle factors, including reduced BMI, increased physical activity intensity, and better medication adherence.

Magnani acknowledged the need for a cost-effectiveness analysis before broader implementation of the program. However, the study’s findings underscore the potential of nurse-led interventions to enhance secondary prevention in ACS patients.