Abstract 3964: GlObal Secondary Prevention StrategiEs to Limit Event Recurrence After Myocardial Infarction: The GOSPEL Study. A trial from the Italian Cardiac Rehabilitation Network: Final Results
Cardiac rehabilitation programs (CRPs) are a proven treatment for pts with recent myocardial infarction (MI), resulting in reduced morbidity and mortality. However, following completion of a CRP, risk factors and lifestyle behavior may deteriorate. The GOSPEL study investigates the benefits of a program of continued educational and behavioral interventions to achieve optimal long-term secondary prevention goals.
Methods. GOSPEL was a multicenter, randomized, controlled study carried out in 78 Italian cardiac rehabilitation centers. After completion of an initial CRP, pts with recent (<3 months) MI were randomized to either a long-lasting (over 3 years) multifactorial continued educational and behavioural program (intensive approach- IA) or usual care (UC) group. IA pts participated in extensive CRP sessions, monthly from months 1 to 6, then every 6 months for 3 years. Each session consisted of aerobic exercise, comprehensive lifestyle and risk factor counseling, and clinical assessment. UC pts returned to their family physicians’ care, and attended the reference Centre only for the 6-month and then annual scheduled assessment. The efficacy of the two different strategies was evaluated in terms of morbidity and mortality as primary end-point.
Results. From January 2001 through December 2002, 3241 pts (58±9 yrs, 86% men, ejection fraction of 53±10%) were enrolled. Compared to UC, the IA was successful over a 3-year follow-up period by inducing a significant improvement (p<.001) in lifestyle habits (exercise, dietary, psychosocial stress and body weight control) and in secondary prevention drug adherence. At 3 years, the combined end-point of cardiac death, MI, stroke, need of revascularization procedure, heart failure and angina requiring hospitalization was 20.5% in the UC and 18.1% in the IA group (12% reduction, p=0.10). Of note, fatal and nonfatal MI were significantly lower in the IA than in the UC group (1.6% vs 3,1% - 48% reduction, p=.009).
Conclusions. A long-lasting, continued multifactorial lifestyle and risk factors intervention following an initial CRP after MI resulted in significant benefits to global cardiovascular risk and was effective in preventing the occurrence of new episodes of MI over a period of 3-year follow-up.