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Original Investigation |

An Education Program for Risk Factor Management After an Acute Coronary Syndrome:  A Randomized Clinical Trial

Ariel Cohen, MD, PhD1; Patrick Assyag, MD2; Louise Boyer-Chatenet1; Alain Cohen-Solal, MD, PhD3; Christel Perdrix, MD4; Marie Dalichampt, MSc5; Pierre-Louis Michel, MD6; Gilles Montalescot, MD, PhD6; Philippe Ravaud, MD, PhD5,7,8; P. Gabriel Steg, MD9,10; Isabelle Boutron, MD, PhD5,7,8 ; for the Réseau Insuffisance Cardiaque (RESICARD) PREVENTION Investigators
[+] Author Affiliations
1Service de Cardiologie, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
2currently in private practice, Paris, France
3Service de Cardiologie, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale Unité 738, Paris, France
4Service de Cardiologie, Hôpital La Roseraie, Aubervilliers, France
5Centre d’Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
6Institut Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Paris 6 (Université Pierre et Marie Curie), Institut National de la Santé et de la Récherche Médicale Commission Médicale Régionale 937, Paris, France
7Institut National de la Santé et de la Recherche Médicale Unité 738, Paris, France
8Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
9Département Hospitalo-Universitaire Fibrosis-Inflammation-Remodeling (FIRE), Hôpital Bichat, Assistance Publique des Hôpitaux de Paris, Paris, France
10Service de Cardiologie, Institut National de la Santé et de la Recherche Médicale INSERM Unité 698, Université Paris Diderot, Paris, France
JAMA Intern Med. 2014;174(1):40-48. doi:10.1001/jamainternmed.2013.11342.
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Importance  Lifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve.

Objective  To determine whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome.

Design, Setting, and Participants  The Réseau Insuffisance Cardiaque (RESICARD) PREVENTION study was a 2-arm, parallel-group, multicenter, randomized clinical trial at 6 tertiary care hospitals in France. Patients hospitalized in a cardiac intensive care unit for an acute coronary syndrome with at least 1 lifestyle risk factor (current smoking, sedentary lifestyle, or overweight or obesity) were randomized according to a computer-generated list with sequentially numbered, sealed envelopes.

Intervention  Patients underwent an education program in a unique non–hospital setting (a House of Education) or were treated according to physicians’ usual standard of care.

Main Outcomes and Measures  The primary outcome was a composite that included at least 1 of the following: smoking cessation, at least 3 hours per week of physical activity, at least 5% reduction in weight, and at least 4% reduction in waist circumference. Patients were followed up for 1 year. An intent-to-treat analysis was performed.

Results  From June 21, 2006, to July 30, 2008, a total of 251 patients were randomized to the House of Education and 251 to conventional care. The 2 groups did not differ significantly at 12 months in the primary composite outcome (51.8% vs 49.8% success rate; adjusted relative risk [aRR], 1.11; 95% CI, 0.90-1.37) or with correction of all risk factors (aRR, 1.22; 95% CI, 0.89-1.66). Similarly, the 2 groups did not differ by physical activity (aRR, 1.05; 95% CI, 0.92-1.21), smoking cessation (aRR, 0.99; 95% CI, 0.87-1.13), and weight or waist reduction (aRR, 1.07; 95% CI, 0.84-1.36).

Conclusions and Relevance  Compared with conventional care, the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome.

Trial Registration  clinicaltrials.gov Identifier: NCT00337480

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Figure 1.
Description of the Experimental Intervention

Patients attended the House of Education at least 6 times: within the first month after discharge and then at months 2, 3, 6, 9, and 12.

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Figure 2.
Flow of Patients in the Study

From June 21, 2006, to July 30, 2008, a total of 251 patients were randomized to the House of Education and 251 to conventional care.

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Figure 3.
Adherence to Individual Consultations With the Nurse (A) and the Dietician (B)

The percentages are based on the number of patients who were expected to have a consultation with the nurse (n = 126) and with the dietician (n = 207).

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