title: The Nurse-Based Age Independent Intervention to Limit Evolution of Disease After Acute Coronary Syndrome (NAILED ACS) Risk Factor Trial: Protocol for a Randomized Controlled Trial.
abstract: BACKGROUND
  Secondary prevention after acute coronary syndrome (ACS) is essential to reduce morbidity and mortality, but related studies have been fairly small or performed as clinical trials with non-representative patient selection. Long-term follow-up data are also minimal. A nurse-led follow-up for risk factor improvement may be effective, but the evidence is limited.
  
  
  OBJECTIVE
  The aims of this study are to perform an adequately sized, nurse-led, long-term secondary preventive follow-up with inclusion of an unselected population of ACS patients. The focus will be on lipid and blood pressure control as well as tobacco use and physical activity.
  
  
  METHODS
  The study will consist of a randomized, controlled, long-term, population-based trial with two parallel groups. Patients will be included during the initial hospital stay. Important outcome variables are total cholesterol, low-density lipoprotein (LDL) cholesterol, and sitting systolic and diastolic blood pressure. Outcomes will be measured after 12, 24, and 36 months of follow-up. Trained nurses will manage the intervention group with the aim of achieving set treatment goals as soon as possible. The control group will receive usual care. At least 250 patients will be included in each group to reliably detect a difference in mean LDL of 0.5 mmol/L and in mean systolic blood pressure of 5 mmHg.
  
  
  RESULTS
  The study is ongoing and recruitment of participants will continue until December 31, 2014.
  
  
  CONCLUSIONS
  This study will test the hypothesis that a nurse-led, long-term follow-up after an ACS with a focus on achieving treatment goals as soon as possible is an effective secondary preventive method. If proven effective, this method could be implemented in general practice at a low cost.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 96595458; http://www.controlled-trials.com/ISRCTN96595458 (Archived by WebCite at http://www.webcitation.org/6RlyhYTYK).
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden. thomas.mooe@medicin.umu.se.
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0003-4821-246X
authors.initials: T
authors.lastname: Mooe
authors.forename: Fredrik
authors.identifier: http://orcid.org/0000-0003-3183-5070
authors.initials: F
authors.lastname: Björklund
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0003-4428-9371
authors.initials: A
authors.lastname: Graipe
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0002-4938-3191
authors.initials: D
authors.lastname: Huber
authors.forename: Stina
authors.identifier: http://orcid.org/0000-0002-2711-1216
authors.initials: S
authors.lastname: Jakobsson
authors.forename: Ulf
authors.identifier: http://orcid.org/0000-0002-3958-132X
authors.initials: U
authors.lastname: Kajermo
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0003-4519-629X
authors.initials: A
authors.lastname: Strömvall
authors.forename: Anders
authors.identifier: http://orcid.org/0000-0003-1222-6552
authors.initials: A
authors.lastname: Ulvenstam
keywords: acute coronary syndrome; cardiovascular disease; myocardial infarction; randomized controlled trial; secondary prevention