Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial

BMC Cardiovascular Disorders

Jarle Jortveit¹  Serena Tonstad²  Anete Kaldal³ 

[1] Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway;Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway;Department of Research, Sørlandet Hospital HF, Box 416, Lundsiden, 4604, Kristiansand S, Norway;

关键词: Myocardial infarction;    Cardiovascular diseases;    Secondary prevention;   

DOI  :  10.1186/s12872-021-02426-3

来源: Springer

【 摘 要 】

Background and aimsDespite established guidelines on secondary prevention of cardiovascular disease, practical implementation of treatment targets is deficient even in high-income countries. This study compared long-term hospital-based treatment with follow-up at primary health care regarding new cardiovascular events and achievement of treatment targets.MethodsThis randomized controlled trial at Sørlandet Hospital, Norway 2007–2021 included patients hospitalized due to myocardial infarction (n = 760) or after scheduled percutaneous coronary intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103). Patients were randomized to hospital-based secondary preventive care with consultations 2 weeks, 3 months, 6 months and 1 year after the index event and annually for up to 5 years, or follow-up at primary health care. Final data was collected after 10 years and hazard ratios were calculated using Cox regression analyses.ResultsComposite endpoint-free survival due to a lower rate of PCI improved in patients with hospital-based follow-up (n = 788) compared to patients followed-up at primary health care (n = 752) (HR 0.80, 95% CI 0.66–0.96; p = 0.02) but all-cause mortality was not reduced (HR 0.96, 95% CI 0.59–1.56; p = 0.86). At 1 year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001) and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p < 0.001) were lower in the hospital-based group, and the differences remained significant during the first 5 years. Other secondary preventive measures (smoking cessation, physical activity, body weight, glucose control, drug adherence) did not differ.ConclusionsLong-term hospital-based secondary preventive follow-up improved composite endpoint-free survival, but not mortality. Substantial risk factors remained unaddressed. The beneficial effects on blood pressure and LDL-cholesterol disappeared after annual consultations ceased.Trial registration: The study is registered in ClinicalTrials.gov (NCT00679237) May 16, 2008.

【 授权许可】

CC BY