Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial

Anete Kaldal, Serena Tonstad, Jarle Jortveit, Anete Kaldal, Serena Tonstad, Jarle Jortveit

Abstract

Background and aims: Despite established guidelines on secondary prevention of cardiovascular disease, practical implementation of treatment targets is deficient even in high-income countries. This study compared long-term hospital-based treatment with follow-up at primary health care regarding new cardiovascular events and achievement of treatment targets.

Methods: This randomized controlled trial at Sørlandet Hospital, Norway 2007-2021 included patients hospitalized due to myocardial infarction (n = 760) or after scheduled percutaneous coronary intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103). Patients were randomized to hospital-based secondary preventive care with consultations 2 weeks, 3 months, 6 months and 1 year after the index event and annually for up to 5 years, or follow-up at primary health care. Final data was collected after 10 years and hazard ratios were calculated using Cox regression analyses.

Results: Composite endpoint-free survival due to a lower rate of PCI improved in patients with hospital-based follow-up (n = 788) compared to patients followed-up at primary health care (n = 752) (HR 0.80, 95% CI 0.66-0.96; p = 0.02) but all-cause mortality was not reduced (HR 0.96, 95% CI 0.59-1.56; p = 0.86). At 1 year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001) and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p < 0.001) were lower in the hospital-based group, and the differences remained significant during the first 5 years. Other secondary preventive measures (smoking cessation, physical activity, body weight, glucose control, drug adherence) did not differ.

Conclusions: Long-term hospital-based secondary preventive follow-up improved composite endpoint-free survival, but not mortality. Substantial risk factors remained unaddressed. The beneficial effects on blood pressure and LDL-cholesterol disappeared after annual consultations ceased.

Trial registration: The study is registered in ClinicalTrials.gov (NCT00679237) May 16, 2008.

Keywords: Cardiovascular diseases; Myocardial infarction; Secondary prevention.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Number of patients at screening, randomization, inclusion in data analysis and participating in study at each follow-up consultation
Fig. 3
Fig. 3
Survial (a) and composite endpoint-free survival (b) and in patients with and without hospital secondary preventive follow-up program after myocardial infarction (MI), percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
Fig. 4
Fig. 4
Proportion of smokers (a), blood pressure (b), LDL-cholesterol levels (c) and mean body mass index (BMI) (d) during study follow-up

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