Nurse-led secondary prevention reduces MACE in post-ACS patients

ACC.25 – In ALLEPRE, a fully nurse-coordinated prevention program reduced MACE risk, increased exercise intensity, and improved medication adherence in high-risk ACS patients, compared with standard care.

This summary is based on the presentation of Giulia Magnani, MD, PhD (Parma, Italy) at the ACC.25 Scientific Session - Alliance For Secondary Prevention After An Acute Coronary Syndrome.

Introduction and methods

Secondary prevention after ACS is important to reduce recurrent CV events, but its implementation in daily clinical practice is suboptimal. Active involvement of nurses in secondary prevention programs has shown positive short-term effects, but long-term and measurable data are lacking.

In the ALLEPRE (ALLiance for sEcondary PREvention after an acute coronary syndrome) trial, a multicenter, pragmatic, intervention RCT, 2057 hospitalized patients for ACS in the Emilia-Romagna region of Italy, were randomized before discharge to a structured, intensive, fully nurse-coordinated prevention program (NCPP) or standard care. Participants in the intervention group attended 9 one-to-one sessions with experienced cardiology nurses with the aim of identifying CVD risk factors, promoting a healthy lifestyle, and monitoring medication adherence.

The primary clinical endpoint was the incidence of adjudicated MACE, a composite outcome of CV death, nonfatal MI, or nonfatal stroke, at 5 years (maximum follow-up duration: 7 years). Secondary endpoints included a composite outcome of MACE or ischemia-driven revascularization, the individual components of the primary endpoint, and all-cause mortality.

Main results

• At 7-year follow-up, the rate of MACE was 16.2% in patients randomized to the NCPP and 22.6% in those receiving standard care (HR: 0.70; 95%CI: 0.57–0.85; P=0.0004), which was mainly driven by a lower incidence of nonfatal MI (9.3% vs. 15.2%; HR: 0.60; 95%CI: 0.46–0.77; P=0.0001).
• The secondary composite endpoint of MACE or ischemia-driven revascularization occurred in 19.0% of the patients in the NCPP group and 24.5% of those in the standard-care group (HR: 0.77; 95%CI: 0.64–0.92; P=0.005).
• Use of the NCPP also slightly reduced the mean BMI compared with standard care (P=0.003) and increased physical exercise intensity (OR: 1.52; 95%CI: 1.26–1.83; P<0.0001) and medication adherence (OR: 1.54; 95%CI: 1.21–1.96; P<0.001).

Conclusion

In the ALLEPRE trial, the NCPP reduced MACE risk in high-risk ACS patients compared with standard care. The program also resulted in good BMI control, increased physical exercise intensity, and better medication adherence.

- Our reporting is based on the information provided at the ACC.25 Scientific Session -