New research published in the November 10 issue of Archives of Internal Medicine reveals that it may be possible to reduce the risk of a second non-fatal heart attack by participating in an intensive, comprehensive, long-term secondary prevention program. Pantaleo Giannuzzi, M.D. (Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy) and colleagues also found that the prevention program – that lasts up to three years after cardiac rehabilitation – also reduces the risk of other cardiovascular events.
Two decades ago, a heart disease diagnosis would lead to a cardiac rehabilitation program based solely on exercise-type interventions. As medical treatment has evolved, help with smoking cessation, diet, risk factors, and lifestyle habits have been added to this rehabilitation plan. One issue with current rehabilitation procedures, however, is their reliance on short-term interventions. Patients never reach therapeutic goals, and thus preclude long-term benefits.
To test a long-term, reinforced, multifactorial educational and behavioral intervention after a standard period of rehabilitation, Giannuzzi and colleagues conducted the Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL) study. The analysis consisted of 3,241 patients who had a heart attack: 1,620 who were randomly assigned to the long-term treatment group and 1,621 randomly assigned to a group that received usual care.
“The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines,” write the researchers. The long-term treatment group also received comprehensive one-on-one support sessions every month for six months and then once every six months for three years.
About 17% of the patients (556 of 3,241) experienced some type of cardiovascular event. The researchers report that 16.1% of the long-term treatment group and 18.2% of the usual care group – not significantly different figures – had heart events such as cardiovascular death, non-fatal heart attack, non-fatal stroke and hospitalization for chest pain, heart failure or an emergency revascularization procedure that restored blood flow. However, those who received long-term treatment did have a significant decrease in incidence of individual heart events and a few combination outcomes. For example, patients in the long-term care group were 33% less likely to experience cardiovascular death plus non-fatal heart attack and stroke, 36% less likely to experience cardiac death plus non-fatal heart attack, and 48% less likely to experience non-fatal heart attack.
“A marked improvement in lifestyle habits (i.e., exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group,” write the researchers.
Giannuzzi and colleagues conclude that, “After three years, the integrated, multifactorial, reinforced approach proved effective in countering the risk factors and medication adherence deterioration over time and was able to induce a considerable improvement in lifestyle habits.” They add: “In line with such results, all the clinical end points were reduced by the intensive intervention.”
Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction: Results of the GOSPEL Study, a Multicenter, Randomized Controlled Trial From the Italian Cardiac Rehabilitation Network
Pantaleo Giannuzzi; Pier Luigi Temporelli; Roberto Marchioli; Aldo Pietro Maggioni; Gianluigi Balestroni; Vincenzo Ceci; Carmine Chieffo; Marinella Gattone; Raffaele Griffo; Carlo Schweiger; Luigi Tavazzi; Stefano Urbinati; Franco Valagussa; Diego Vanuzzo; for the GOSPEL Investigators
Archives of Internal Medicine (2008); 168[20]: pp. 2194-2204.
Written by: Peter M Crosta