Abstract 5130: Efficacy of Two Long-Term Intervention Strategy to Promote Long-Term Adherence to Lifestyle Changes and to Reduce Cardiovascular Event in Patients with Coronary Artery Disease
It is known that an incomplete adherence to life style changes and to medical treatment is responsible of an increase number of cardiovascular events (CE) in the follow-up (FU).
Aim. We assessed the hypothesis that an economic and simple long term support can help coronary pts to improve adherence and to reduce CE, testing two different low-cost long- term strategy (12 months). 611 pts (57±9 y), after an acute coronary event, were randomised into 3 groups: usual care (G1,214 pts); phone FU group (G2,193 pts), intensive long-term intervention group (G3,204 pts). The G2 pts were called every month by a nurse to reinforce adherence to medical treatment and physical activity recommended and to check progress regarding lifestyle and other risk factors changes; the G3 pts underwent, every 3 months, 2 hours of a risk factors-education-counselling session managed by nurse. After 1 year all pts were evaluated for risk factors and CE. The CE were re-evaluated again 1 year later. at 1 year-FU the LDL cholesterol was 125±19 mg% in G1, 106±16 mg% in G2 (p<0.01 vs G1) and 101±22 mg% in G3 (p<0.01 vs G1 and G2); among the 364 pts smoking before the coronary event, the % of smokers at FU was: 38% in G1, 40% in G2, and 10% in G3 (p<0.01 vs G1 and G2). The complete adherence to medical treatment was 47% in G1, 66% in G2(p <0.01 vs G1), and 91% in G3 (p<0.01 vs G1 and G2), while the adherence to physical activity was 15% in G1, 49% in G2 (p <0.01 vs G1) and 83% in G3 (p<0.01 vs G1 and G2). Blood pressure in hypertensive pts was uncontrolled in 50% of G1, 17% in G2 and only 10% of G3 pts (p <0.001 vs G1) After 1 year no differences were observed in total and cardiovascular mortality and myocardial infarction in the different groups, but the number of the new hospitalisations for non-fatal CE (chest pain, angina, heart failure) was higher in G1 (28%) and G2 (21%) than in G3 (14,2%)(p<0.01 vs G1 and G2). After 2 years FU, a significant (p=0.003) reduction in the incidence of non fatal myocardial infarction was observed only in G3 pts. Both long-term low-cost strategies were effective in increasing adherence to lifestyle changes and to medical treatment: a more direct and intensive strategy had better efficacy and impact on non-fatal cardiovascular events and re-hospitalisations.