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Long-Term Effects of an Intensive Prevention Program After Acute Myocardial Infarction

      Effective long-term prevention after myocardial infarction (MI) is crucial to reduce recurrent events. In this study the effects of a 12-months intensive prevention program (IPP), based on repetitive contacts between non-physician “prevention assistants” and patients, were evaluated. Patients after MI were randomly assigned to the IPP versus usual care (UC). Effects of IPP on risk factor control, clinical events and costs were investigated after 24 months. In a substudy efficacy of short reinterventions after more than 24 months (“Prevention Boosts”) was analyzed. IPP was associated with a significantly better risk factor control compared to UC after 24 months and a trend towards less serious clinical events (12.5% vs 20.9%, log-rank p = 0.06). Economic analyses revealed that already after 24 months cost savings due to event reduction outweighted the costs of the prevention program (costs per patient 1,070 € in IPP vs 1,170 € in UC). Short reinterventions (“Prevention Boosts”) more than 24 months after MI further improved risk factor control, such as LDL cholesterol and blood pressure lowering. In conclusion, IPP was associated with numerous beneficial effects on risk factor control, clinical events and costs. The study thereby demonstrates the efficacy of preventive long-term concepts after MI, based on repetitive contacts between non-physician coworkers and patients.
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      References

        • Kotseva K
        • De Backer G
        • De Bacquer D
        • Ryden L
        • Hoes A
        • Grobbee D
        • Maggioni A
        • Marques-Vidal P
        • Jennings C
        • Abreu A
        • Aguiar C
        • Badariene J
        • Bruthans J
        • Castro Conde A
        • Cifkova R
        • Crowley J
        • Davletov K
        • Deckers J
        • De Smedt D
        • De Sutter J
        • Dilic M
        • Dolzhenko M
        • Dzerve V
        • Erglis A
        • Fras Z
        • Gaita D
        • Gotcheva N
        • Heuschmann P
        • Hasan-Ali H
        • Jankowski P
        • Lalic N
        • Lehto S
        • Lovic D
        • Mancas S
        • Mellbin L
        • Milicic D
        • Mirrakhimov E
        • Oganov R
        • Pogosova N
        • Reiner Z
        • Stoerk S
        • Tokgozoglu L
        • Tsioufis C
        • Vulic D
        • Wood D
        Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry.
        Eur J Prev Cardiol. 2019; 26: 824-835
        • Shah ND
        • Dunlay SM
        • Ting HH
        • Montori VM
        • Thomas RJ
        • Wagie AE
        • Roger VL.
        Long-term medication adherence after myocardial infarction: experience of a community.
        Am J Med. 2009; 122 (e7-13): 961
        • Wood DA
        • Kotseva K
        • Connolly S
        • Jennings C
        • Mead A
        • Jones J
        • Holden A
        • De Bacquer D
        • Collier T
        • De Backer G
        • Faergeman O.
        Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial.
        Lancet. 2008; 371: 1999-2012
        • Minneboo M
        • Lachman S
        • Snaterse M
        • Jorstad HT
        • Ter Riet G
        • Boekholdt SM
        • Scholte Op Reimer WJM
        • Peters RJG
        Community-based lifestyle intervention in patients with coronary artery disease: the RESPONSE-2 Trial.
        J Am Coll Cardiol. 2017; 70: 318-327
        • Sunamura M
        • Ter Hoeve N
        • van den Berg-Emons RJG
        • Geleijnse ML
        • Haverkamp M
        • Stam HJ
        • Boersma E
        • van Domburg RT
        Randomised controlled trial of two advanced and extended cardiac rehabilitation programmes.
        Heart. 2018; 104: 430-437
        • Mayer-Berger W
        • Simic D
        • Mahmoodzad J
        • Burtscher R
        • Kohlmeyer M
        • Schwitalla B
        • Redaelli M.
        Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study.
        Eur J Prev Cardiol. 2014; 21: 145-152
        • Wienbergen H
        • Fach A
        • Meyer S
        • Meyer J
        • Stehmeier J
        • Backhaus T
        • Michel S
        • Kraemer K
        • Osteresch R
        • Schmucker J
        • Haase H
        • Haerle T
        • Elsasser A
        • Hambrecht R.
        Effects of an intensive long-term prevention programme after myocardial infarction - a randomized trial.
        Eur J Prev Cardiol. 2019; 26: 522-530
        • Doimo S
        • Fabris E
        • Piepoli M
        • Barbati G
        • Antonini-Canterin F
        • Bernardi G
        • Maras P
        • Sinagra G.
        Impact of ambulatory cardiac rehabilitation on cardiovascular outcomes: a long-term follow-up study.
        Eur Heart J. 2019; 40: 678-685
        • Rauch B
        • Davos CH
        • Doherty P
        • Saure D
        • Metzendorf MI
        • Salzwedel A
        • Voeller H
        • Jensen K
        • Schmid JP.
        The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: a systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS).
        Eur J Prev Cardiol. 2016; 23: 1914-1939
        • Hansen D
        • Piepoli MF
        • Doehner W.
        The importance of rehabilitation in the secondary prevention of cardiovascular disease.
        Eur J Prev Cardiol. 2019; 26: 273-276
        • Kuepper-Nybelen J
        • Rothenbacher D
        • Hahmann H
        • Wusten B
        • Brenner H.
        Changes of risk factors in patients with coronary heart disease after in-patient rehabilitation.
        Dtsch Med Wochenschr. 2003; 128: 1525-1530
        • Kotseva K.
        The EUROASPIRE surveys: lessons learned in cardiovascular disease prevention.
        Cardiovasc Diagn Ther. 2017; 7: 633-639
        • Mangiapane S
        • Busse R.
        Prescription prevalence and continuing medication use for secondary prevention after myocardial infarction: the reality of care revealed by claims data analysis.
        Dtsch Aerztebl Int. 2011; 108: 856-862
        • Khan MA
        • Hashim MJ
        • Mustafa H
        • Baniyas MY
        • Al Suwaidi S
        • AlKatheeri R
        • Alblooshi FMK
        • Almatrooshi M
        • Alzaabi MEH
        • Al Darmaki RS
        • Lootah S
        Global epidemiology of Ischemic heart disease: results from the global burden of disease study.
        Cureus. 2020; 12: e9349
        • Hansen D
        • Dendale P
        • Coninx K
        • Vanhees L
        • Piepoli MF
        • Niebauer J
        • Cornelissen V
        • Pedretti R
        • Geurts E
        • Ruiz GR
        • Corra U
        • Schmid JP
        • Greco E
        • Davos CH
        • Edelmann F
        • Abreu A
        • Rauch B
        • Ambrosetti M
        • Braga SS
        • Barna O
        • Beckers P
        • Bussotti M
        • Fagard R
        • Faggiano P
        • Garcia-Porrero E
        • Kouidi E
        • Lamotte M
        • Neunhauserer D
        • Reibis R
        • Spruit MA
        • Stettler C
        • Takken T
        • Tonoli C
        • Vigorito C
        • Voeller H
        • Doherty P.
        The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.
        Eur J Prev Cardiol. 2017; 24: 1017-1031
        • Burke LE
        • Ma J
        • Azar KM
        • Bennett GG
        • Peterson ED
        • Zheng Y
        • Riley W
        • Stephens J
        • Shah SH
        • Suffoletto B
        • Turan TN
        • Spring B
        • Steinberger J
        • Quinn CC
        Current science on consumer use of mobile health for cardiovascular disease prevention: a scientific statement from the American Heart Association.
        Circulation. 2015; 132: 1157-1213
        • Mega JL
        • Stitziel NO
        • Smith JG
        • Chasman DI
        • Caulfield M
        • Devlin JJ
        • Nordio F
        • Hyde C
        • Cannon CP
        • Sacks F
        • Poulter N
        • Sever P
        • Ridker PM
        • Braunwald E
        • Melander O
        • Kathiresan S
        • Sabatine MS.
        Genetic risk, coronary heart disease events, and the clinical benefit of statin therapy: an analysis of primary and secondary prevention trials.
        Lancet. 2015; 385: 2264-2271
        • Kullo IJ
        • Jouni H
        • Austin EE
        • Brown SA
        • Kruisselbrink TM
        • Isseh IN
        • Haddad RA
        • Marroush TS
        • Shameer K
        • Olson JE
        • Broeckel U
        • Green RC
        • Schaid DJ
        • Montori VM
        • Bailey KR.
        Incorporating a genetic risk score into coronary heart disease risk estimates: effect on low-density lipoprotein cholesterol levels (the MI-GENES Clinical Trial).
        Circulation. 2016; 133: 1181-1188
        • Wienbergen H
        • Fach A
        • Erdmann J
        • Katalinic A
        • Eisemann N
        • Krawitz P
        • Maj C
        • Borisov O
        • Munz M
        • Noethen M
        • Meyer-Saraei R
        • Osteresch R
        • Schmucker J
        • Linke A
        • Eitel I
        • Hambrecht R
        • Langer H.
        New technologies for intensive prevention programs after myocardial infarction: rationale and design of the NET-IPP trial.
        Clin Res Cardiol. 2021; 110: 153-161