Nurse-led telephone-based follow-up of secondary prevention after acute coronary syndrome: One-year results from the randomized controlled NAILED-ACS trial

Abstract

BackgroundSecondary prevention after acute coronary syndrome (ACS) could reduce morbidity and mortality, but guideline targets are seldom reached. We hypothesized that nurse-led telephone-based intervention would increase adherence.MethodsThe NAILED ACS trial is a prospective, controlled, randomized trial. Patients admitted for ACS at Östersund hospital, Sweden, were randomized to usual follow-up by a general practitioner or a nurse-led intervention. The intervention comprised telephone follow-up after 1 month and then yearly with lifestyle counselling and titration of medications until reaching target values for LDL-C (<2.5 mmol/L) and blood pressure (BP; <140/90 mmHg) or set targets were deemed unachievable. This is a 12-month exploratory analysis of the intervention.ResultsA total of 768 patients (396 intervention, 372 control) completed the 12-month follow-up. After titration at the 1-month follow-up, mean LDL-C was 0.38 mmol/L (95% CI 0.28 to 0.48, p<0.05), mean systolic BP 7 mmHg (95% CI 4.5 to 9.2, p<0.05), and mean diastolic BP 4 mmHg (95% CI 2.4 to 4.1, p<0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met by 94.1% and 91.9% of intervention patients and 68.4% and 65.6% of controls (p<0.05). At 12 months, mean LDL was 0.3 mmol/L (95% CI 0.1 to 0.4, p <0.05), systolic BP 1.5 mmHg (95% CI -1.0 to 4.1, p = 0.24), and mean diastolic BP 2.1 mmHg (95% CI 0.6 to 3.6, p <0.05) lower in the intervention group. Target values for LDL-C and systolic BP were met in 77.7% and 68.9% of intervention patients and 63.2% and 63.7% of controls (p<0.05 and p = 0.125).ConclusionNurse-led telephone-based secondary prevention was significantly more efficient at improving LDL-C and diastolic BP levels than usual care. The effect of the intervention declined between 1 and 12 months. Further evaluation of the persistence to the intervention is needed.

Effectiveness of telehealth interventions as a part of secondary prevention in coronary artery disease: a systematic review and meta‐analysis

“…In total, 11 studies about lipid changes , 11 studies about blood pressure , eight studies about smoking cessation , 13 studies about physical activity , eight studies about medication adherence and four studies about waist circumference were eventually included (summary of study characteristics) (Fig. ).…”

“…Fourteen studies were published between 2015 and 2017, and ten studies between 2003 and 2014. Four studies were conducted in Australia , four in the United States , three in Canada , two each in New Zealand , Sweden and Norway , and one in each of the following countries: Belgium , Italy , Malaysia , Netherlands , Germany , Korea and Iceland .…”

“…When the types of intervention were examined, it was found that four types of intervention were used in the studies: text messages, telephone calls, telephone calls in combination with messages and telemonitoring. It was determined that telephone calls were the most commonly used intervention in 11 studies and text messages came second intervention with seven studies . It was found that telephone calls in combination with messages were used in four studies and telemonitoring was used in two studies (Table ).…”

“…Telehealth interventions are cost‐effective, fast and useful, and provide effective solutions; they have an important role in maintaining regular and continuous communication with the patient, and can be used in monitoring, training and consulting the patient . There have been many randomised controlled trials (RCTs) with telehealth interventions to reduce risk factors and improve adherence to lifestyle changes such as medication, physical activity, smoking cessation, blood pressure, lipids, physical activity and waist circumference; in physical activity , medication adherence , smoking cessation , lipid changes and risk factor modification . Results from these studies support the beneficial effect of telehealth interventions within CAD management programs on adherence to lifestyle changes.…”

What is the best way of organizing the follow-up of patients with cardiovascular disease?

“…18 Another study also confirmed that a nurse-led, telephone-based secondary prevention programme was significantly more efficient at improving low-density lipoprotein cholesterol levels and diastolic blood pressure than usual care. 19 Marcos-Forniol et al 20 showed that the implementation of a secondary prevention programme in elderly patients was effective in achieving risk factor control goals in patients older than 70 years of age. 20 We conclude that secondary prevention is crucial in patients with cardiovascular disease.…”