Secondary Prevention Beyond Walls Intervention Trial in Women - WITTI Women


The goal of the trial was to evaluate if use of a systematic educational intervention was associated with risk factor reduction compared with usual care among women with heart disease.


Use of a systematic education intervention in addition to usual care will be associated with risk factor reduction compared with usual care among women with heart disease.

Study Design

Patients Screened: 1,152
Patients Enrolled: 304
Mean Follow Up: Six months

Patient Populations:

Hospital admission for acute coronary syndrome, angina, or coronary revascularization procedure


Life expectancy <6 months; non-English or Spanish speaking

Primary Endpoints:

Mean difference in the number of eight prevention goals at six-month follow-up

Drug/Procedures Used:

Patients were randomized to usual care (n=153) or systematic intervention (n=151). The intervention was based on eight goals: smoking cessation, weight management, physical activity, blood pressure <140/90 mm Hg, low-density lipoprotein (LDL) <100 mg/dl, and use of aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.

Follow-up was done with three telephone contacts (two weeks, four weeks, and three months) and two clinic visits (six weeks and six months). Patients were provided with feedback on goals, progress, and barriers at each of the follow-up contacts.

Principal Findings:

There was no significant difference in any of the eight goals met at six-month follow-up or in the proportion of individual goals achieved between the intervention and usual-care groups. The mean number of goals achieved at baseline was 4.7 in both the systematic intervention group and the usual care group.

At six-month follow-up, the mean number of goals achieved was 5.2 and 5.1, respectively. Among the subgroup of minority women, those randomized to the intervention group were 2.4 times more likely than minority women in the usual care arm to achieve blood pressure goals at six months, and a significant interaction for ethnic status and randomization group was observed for achieving the blood pressure reduction goal (p=0.009).


Among women with heart disease, use of a systematic educational intervention was not associated with a reduction in the number of eight prevention goals at six-month follow-up compared with usual care. The presenter suggested that part of the lack of difference by treatment group may be due to poor compliance and poor follow-up in the systematic educational intervention arm.

Additionally, the treatment may not have been intense enough or the duration may not have been long enough. While there was not a difference between treatment groups at follow-up, there were improvements in both arms compared with baseline in some of the goals including LDL reduction, increases in exercise, and smoking.


Mosca L, Christian AH, Mochari-Greenberger H, Kligfield P, Smith SC Jr. A randomized clinical trial of secondary prevention among women hospitalized with coronary heart disease. J Womens Health (Larchmt). 2010 Feb;19(2):195-202.

Presented by Dr. Lori J. Mosca at the November 2003 American Heart Association Annual Scientific Sessions, Orlando, FL.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Lipid Metabolism

Keywords: Acute Coronary Syndrome, Follow-Up Studies, Telephone, Coronary Disease, Blood Pressure, Risk Factors, Lipoproteins, LDL, Motor Activity, Patient Compliance, Smoking Cessation

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