Effects of an intensive long-term prevention programme after myocardial infarction – a randomized trial

Abstract

Background Long-term risk factor control after myocardial infarction (MI) is currently inadequate and there is an unmet need for effective secondary prevention programmes. Design and methods It was the aim of the study to compare a 12-month intensive prevention programme (IPP), coordinated by prevention assistants and including education sessions, telephone visits and telemetric risk factor control, with usual care after MI. Three hundred and ten patients were randomized to IPP vs. usual care one month after hospital discharge for MI in two German heart centres. Primary study endpoint was the IPP Prevention Score (0-15 points) quantifying global risk factor control. Results Global risk factor control was strongly improved directly after MI before the beginning of the randomized study (30% increase IPP Prevention Score). During the 12-month course of the randomized trial the IPP Prevention Score was improved by a further 14.3% in the IPP group ( p < 0.001), while it decreased by 11.8% in the usual care group ( p < 0.001). IPP significantly reduced smoking, low-density lipoprotein cholesterol, systolic blood pressure and physical inactivity compared with usual care ( p < 0.05). Step counters with online documentation were used by the majority of patients (80%). Quality of life was significantly improved by IPP ( p < 0.05). The composite endpoint of adverse clinical events was slightly lower in the IPP group during 12 months (13.8% vs. 18.9%, p = 0.25). Conclusions A novel intensive prevention programme after MI, coordinated by prevention assistants and using personal teachings and telemetric strategies for 12 months, was significantly superior to usual care in providing sustainable risk factor control and better quality of life.

Long-Term Risk Factor Control After Myocardial Infarction—A Need for Better Prevention Programmes

“…In the most recent IPP trial a 12-months intensive prevention programme (IPP) after MI was compared to usual care (UC) [24]: one month after discharge for MI, mostly (96%) after a 3-week cardiac rehabilitation programme, patients were randomly assigned to the IPP for 12 months or UC. IPP was coordinated by a non-physician prevention assistant that was supervised by cardiologists.…”

“…Comparing the RESPONSE II [23] and the IPP [24] trial, both studies investigated a modern long-term prevention programme after acute coronary syndromes and evaluated “prevention success” and “prevention failure” after 12 months. However, in the RESPONSE II trial exclusively lifestyle interventions (such as “Weight Watchers ® ”) were performed and the three “lifestyle risk factors”; body weight, physical inactivity and smoking, were defining “prevention success” or “prevention failure”.…”

Update Lebensstil – Was funktioniert in der Praxis?

“…Abb. 1 Effekte eines 12-monatigen intensiven Präventionsprogramms nach 3-wöchiger Rehabilitation nach akutem Myokardinfarkt[11]. Der IPP-Präventionsscore bewertet die globale Einstellung der Risikofaktoren (beste Einstellung = 15 Punkte).…”

“…am höchsten und nimmt dann im Lang-zeitverlauf wieder ab, wenn der Patient nach einer 3-wöchigen poststationären Rehabilitation in sein gewohntes Umfeld zurückkehrt[10].Deshalb werden zunehmend langfristige Präventionskonzepte entwickelt, die bei Patienten mit koronarer Herzkrankheit dazu dienen sollen, die Motivation bezüglich eines gesunden Lebensstils nachhaltig hoch zu halten. Die aktuellste Studie zu diesem Thema ist die IPP-Studie[11].An 2 deutschen Herzzentren wurden Patienten mit akutem Myokardinfarkt randomisiert einem intensiven Präventionsprogramm (IPP) für 12 Monate oder Standardversorgung zugeteilt. Bei dem Präventionsprogramm spielten nicht ärztliche medizinische Präventionsassistenten eine Schlüsselrolle, die einen engmaschigen Kontakt zu Patienten und Angehörigen hielten und sich auch darum kümmerten, dass die Hausärzte der Patienten in die Behandlungsempfehlungen eingebunden wurden.…”

“…Schrittzähler als Methode zur Steigerung der körperlichen Aktivität -Rate der Nutzer und Zunahme der Schrittzahlen im Rahmen eines intensiven Präventionsprogramms nach akutem Myokardinfarkt (IPP-Studie[11]). ▪ Unterstützung der Prävention durch gut fortgebildete Ärzte (neue Sachkunde "Spezielle kardiovaskuläre Prävention" der Deutschen Gesellschaft für Kardiologie)[12].…”