Patient-centered modular secondary prevention following acute coronary syndrome: a randomized controlled trial.
OBJECTIVE
Cardiac rehabilitation (CR) is beneficial for those who attend, but alternative models for nonattenders need investigation. We tested the effectiveness of modular prevention on risk factors in survivors of acute coronary syndrome (ACS) not accessing CR.


METHODS
We randomly allocated ACS survivors not accessing CR to a control group (n = 72) receiving conventional care or modular group (n = 72) who participated in risk factor modules on the basis of patient-centered care and collaborative goal setting to systematically lower risk factors. We also recruited a consecutive reference group of ACS survivors participating in CR (n = 64). Blinded measurements of risk factors and global risk were completed at baseline and 3 months.


RESULTS
Although well matched for risk factor level and prevalence at baseline, by 3 months, the modular group had significantly reduced risk factor level in comparison with controls for most risk factors including total cholesterol (158 +/- 3.9 vs 186 +/- 3.9 mg/dL, P < .001), systolic blood pressure (133.5 +/- 2.0 vs 144.4 +/- 2.4 mm Hg, P < .01), body mass index (28.9 +/- 0.7 vs 31.0 +/- 0.7 kg/m, P = .02), and physical activity (1,187 +/- 164 vs 636 +/- 115 metabolic equivalents [METS]/kg/min, P < .01). Also at 3 months, fewer patients in the modular group smoked than in the control group (6% vs 23%, P < .01) and were in the moderate to high-risk category of the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) score (40% vs 59%, P = .02). Although the modular group had higher risk factors at baseline, they achieved similar mean levels as the CR group at 3 months.


CONCLUSIONS
Patient-centered modular prevention significantly improves coronary risk profile in comparison with conventional care and provides an effective alternative for the large numbers of ACS survivors not accessing CR.
Redfern
Julie
J
Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. julieredfern@dodo.com.au
Briffa
Tom
T
Ellis
Elizabeth
E
Freedman
Saul B
SB
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012046:Rehabilitation / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D016037:Single-Blind Method