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Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction
- Source :
- Archives of Internal Medicine. 168:2194
- Publication Year :
- 2008
- Publisher :
- American Medical Association (AMA), 2008.
-
Abstract
- Background Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a long-term, relatively intensive rehabilitation strategy after MI. Methods We conducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n = 1620) or usual care (control group; n = 1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration ClinicalTrials.gov Identifier:NCT00421876
- Subjects :
- Male
medicine.medical_specialty
Myocardial Infarction
GOSPEL
Angina Pectoris
law.invention
Angina
Randomized controlled trial
law
Internal medicine
Myocardial Revascularization
Secondary Prevention
Internal Medicine
medicine
Clinical endpoint
Humans
Myocardial infarction
Life Style
Stroke
Heart Failure
Cardiac Rehabilitation
business.industry
Surrogate endpoint
Hazard ratio
Middle Aged
medicine.disease
Heart failure
Physical therapy
Female
business
Stress, Psychological
Subjects
Details
- ISSN :
- 00039926
- Volume :
- 168
- Database :
- OpenAIRE
- Journal :
- Archives of Internal Medicine
- Accession number :
- edsair.doi.dedup.....cb7f6aadd6e1e41084c11c041401cdce