Long-term secondary prevention program may help reduce cardiovascular risks after heart attack

November 10, 2008

An intensive, comprehensive, long-term secondary prevention program lasting up to three years after cardiac rehabilitation appears to reduce the risk of a second non-fatal heart attack and other cardiovascular events, according to a report in the November 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Cardiac rehabilitation programs after a heart disease diagnosis have evolved over two decades from solely exercise-based interventions, according to background information in the article. Now, rehabilitation includes helping patients with smoking cessation, diet, risk factors, and lifestyle habits. However, current rehabilitation procedures rely on short-term interventions that are unlikely to yield long-term benefits because patients never reach therapeutic goals.

Pantaleo Giannuzzi, M.D., of the Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy, and colleagues conducted the Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL) study, in which they randomly assigned 1,620 patients who had a heart attack to receive a long-term, reinforced, multifactorial educational and behavioral intervention after a standard period of rehabilitation.

"The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines," the authors write. Comprehensive sessions with one-on-one support were held monthly for six months, then once every six months for three years. Results of patients in this program were compared with those of 1,621 who were randomly assigned to receive usual care.

Overall, 556 patients (17.2 percent) experienced a cardiovascular event. The intervention did not significantly reduce the risk of combined heart events (which occurred in 261 [16.1 percent] of patients in the intervention group and 295 [18.2 percent] in the usual care group), including cardiovascular death, non-fatal heart attack, non-fatal stroke and hospitalization for chest pain, heart failure or an urgent revascularization procedure to restore blood flow. However, the program did significantly decrease incidence of individual heart events and some combinations of outcomes, including a 33 percent reduction in cardiovascular death plus non-fatal heart attack and stroke (3.2 percent in the intervention group vs. 4.8 percent in the usual care group), a 36 percent reduction in cardiac death plus non-fatal heart attack (2.5 percent vs. 4 percent) and a 48 percent reduction in non-fatal heart attack (1.4 percent vs. 2.7 percent).

"A marked improvement in lifestyle habits (i.e., exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group," the authors write.

"After three years, the integrated, multifactorial, reinforced approach proved effective in countering the risk factors and medication adherence deterioration over time and was able to induce a considerable improvement in lifestyle habits," the authors conclude. "In line with such results, all the clinical end points were reduced by the intensive intervention." The results reinforce previous findings that gains achieved with short-term cardiac rehabilitation are not maintained over time and suggest that a more comprehensive, sustained intervention is needed to reduce cardiovascular risks after a heart attack.
-end-
(Arch Intern Med. 2008;168[20]:2194-2204. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: The GOSPEL Study was supported by Società Prodotti Antibiotici with an unrestricted research grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.