title: An education program for risk factor management after an acute coronary syndrome: a randomized clinical trial.
abstract: OBJECTIVE
  Lifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve.
  
  
  OBJECTIVE
  To determine whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome.
  
  
  METHODS
  The Réseau Insuffisance Cardiaque (RESICARD) PREVENTION: study was a 2-arm, parallel-group, multicenter, randomized clinical trial at 6 tertiary care hospitals in France. Patients hospitalized in a cardiac intensive care unit for an acute coronary syndrome with at least 1 lifestyle risk factor (current smoking, sedentary lifestyle, or overweight or obesity) were randomized according to a computer-generated list with sequentially numbered, sealed envelopes.
  
  
  METHODS
  Patients underwent an education program in a unique non-hospital setting (a House of Education) or were treated according to physicians' usual standard of care.
  
  
  METHODS
  The primary outcome was a composite that included at least 1 of the following: smoking cessation, at least 3 hours per week of physical activity, at least 5% reduction in weight, and at least 4% reduction in waist circumference. Patients were followed up for 1 year. An intent-to-treat analysis was performed. RESULTS From June 21, 2006, to July 30, 2008, a total of 251 patients were randomized to the House of Education and 251 to conventional care. The 2 groups did not differ significantly at 12 months in the primary composite outcome (51.8% vs 49.8% success rate; adjusted relative risk [aRR], 1.11; 95% CI, 0.90-1.37) or with correction of all risk factors (aRR, 1.22; 95% CI, 0.89-1.66). Similarly, the 2 groups did not differ by physical activity (aRR, 1.05; 95% CI, 0.92-1.21), smoking cessation (aRR, 0.99; 95% CI, 0.87-1.13), and weight or waist reduction (aRR, 1.07; 95% CI, 0.84-1.36).
  
  
  CONCLUSIONS
  Compared with conventional care, the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00337480.
authors.affiliation: Service de Cardiologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.affiliation: currently in private practice, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Assyag
authors.affiliation: Service de Cardiologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Boyer-Chatenet
authors.affiliation: Service de Cardiologie, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale Unité 738, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: Service de Cardiologie, Hôpital La Roseraie, Aubervilliers, France.
authors.forename: Christel
authors.initials: C
authors.lastname: Perdrix
authors.affiliation: Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Dalichampt
authors.affiliation: Institut Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Paris 6 (Université Pierre et Marie Curie), Institut National de la Santé et de la Récherche Médicale Commission Médicale Régionale 937, Paris, France.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Michel
authors.affiliation: Institut Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Paris 6 (Université Pierre et Marie Curie), Institut National de la Santé et de la Récherche Médicale Commission Médicale Régionale 937, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
authors.affiliation: Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France7Institut National de la Santé et de la Recherche Médicale Unité 738, Paris, France8Faculté de Médecine, Université Paris Descartes, Sorbonne Pari.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: Département Hospitalo-Universitaire Fibrosis-Inflammation-Remodeling (FIRE), Hôpital Bichat, Assistance Publique des Hôpitaux de Paris, Paris, France10Service de Cardiologie, Institut National de la Santé et de la Recherche Médicale INSERM Unité 698, Univ.
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France7Institut National de la Santé et de la Recherche Médicale Unité 738, Paris, France8Faculté de Médecine, Université Paris Descartes, Sorbonne Pari.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boutron
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy; D050177:Overweight / Q000150:complications / Q000628:therapy; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012907:Smoking / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods; D016896:Treatment Outcome; D055105:Waist Circumference