November 11, 2008
(HealthDay News) — Heart attack survivors can significantly reduce their risk of non-fatal coronary recurrence by participating in an intensive, long-term prevention program, according to an Italian study that included 3,240 patients.
After a standard period of post-heart attack rehabilitation, half the patients were assigned to a long-term, multi-faceted educational and behavioral intervention, while the other half received usual care.
“The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines,” the researchers wrote in the Nov. 10 issue of the Archives of Internal Medicine. The patients in the intervention group had comprehensive sessions with one-on-one support monthly for six months, then once every six months for three years. The sessions included helping patients with exercise, diet, weight control and other lifestyle factors.
Overall, 556 patients (17.2 percent) experienced a cardiovascular event during the study. The intervention didn’t significantly reduce the risk of combined heart events (16.1 percent of intervention group and 18.2 percent of usual care group) such as cardiovascular death, non-fatal heart attack, non-fatal stroke, hospitalization for chest pain, heart failure or revascularization procedure to restore blood flow.
However, the intervention did significantly decrease the incidence of individual heart events and some combinations of outcomes, including: a 33 percent reduction in cardiovascular death plus non-fatal heart attack and stroke (3.2 percent in the intervention group vs. 4.8 percent in the usual care group); a 36 percent reduction in cardiac death plus non-fatal heart attack (2.5 percent vs. 4 percent); and a 48 percent reduction in non-fatal heart attack (1.4 percent vs. 2.7 percent).
“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,” the study authors wrote.
The findings reinforce previous research showing gains achieved with short-term cardiac rehabilitation aren’t sustained over time and suggest the need for a more comprehensive, sustained intervention in order to reduce patient’s cardiovascular risks after a heart attack, they concluded.