Implementing a nurse-coordinated prevention program (NCPP) significantly reduced long-term major adverse cardiovascular events (MACE) and improved body weight control, physical activity and pharmacotherapy adherence in post-hospitalization patients with acute coronary syndrome (ACS), according to results from the ALLEPRE trial published May 5 in EHJ.

This multicenter cohort study evaluated 2,057 patients (mean age of 64 years, 22% women) with ACS across seven centers in Italy from October 2012 through March 2022. Patients were randomized to either the NCPP group (n=1,031) or the standard of care (SOC) group (n=1,026).

Patients in the NCPP group attended nine individual educational sessions over four years, where centrally trained nurses who were already involved in ACS follow-up assessed cardiovascular risk profiles, encouraged medication adherence and healthier lifestyles, as well as made multidisciplinary team referrals. Patients in the SOC group followed the standard practices of their respective hospitals.

Giulia Magnani, MD, et al., defined the primary MACE endpoint as the composite of cardiovascular death, nonfatal myocardial infarction (MI) and nonfatal stroke. Secondary endpoints were defined as the primary endpoint plus myocardial ischemia-driven revascularization (IDR), all-cause death, all recurrent primary endpoint events or heart failure hospitalization.

At the six-year follow-up, the rate of MACE was 30% lower in the NCPP group than the SOC group (16% vs. 22%, respectively; hazard ratio [HR], 0.70, p<0.0001), a finding mainly driven by the reduction in nonfatal MI (9% vs. 15%; HR, 0.60; p=0.0001).

Additionally, there was a 23% reduction in the secondary outcome of MACE plus IDR (HR, 0.77; p=0.0005). Body weight, physical activity and medication pharmacotherapy adherence were all significantly improved with the NCPP strategy vs. SOC strategy.

“The results of this trial are particularly relevant as an increasing number of ACS patients are living longer, and there is a growing need for innovative, [patient-centered] models that can counteract the fragmentation of [health care] services,” write the authors. “…including an NCPP in [health care] provision may help the successful implementation of secondary prevention strategies and guarantee clinical efficacy.”