A nurse-coordinated intervention programme vs standard of care after an acute coronary syndrome: the ALLEPRE trial.
Giulia Magnani, Giorgia Paoli, Giuseppe Maglietta et al.
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In 30 seconds
The multicentre, pragmatic, randomized ALLEPRE trial compared a nurse-coordinated prevention programme with hospital standard care in patients recovering from acute coronary syndrome. The programme offered nine individual educational sessions over four years, focused on cardiovascular risk factors, lifestyle, and medication adherence. Compared with standard care, it reduced the primary composite outcome of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke: 16.2% vs 22.6% (HR 0.70; 95% CI 0.57-0.85; P-value <0.001). The reduction was mainly driven by fewer non-fatal myocardial infarctions.
Key findings
- MACE occurred in 16.2% with the nurse-coordinated programme and 22.6% with standard care (HR 0.70; 95% CI 0.57-0.85; P-value <0.001).
- Non-fatal MI occurred in 9.3% vs 15.2% (HR 0.60; 95% CI 0.46-0.77; P-value=0.0001), mainly driving the MACE reduction.
- MACE plus ischaemia-driven revascularization was reduced (HR 0.77, 95% CI 0.64-0.92; P-value= 0.005).
- Exercise frequency, body weight control, and medication adherence improved more with the programme.
Why it matters
The findings suggest that structured nurse-led follow-up can support secondary prevention after acute coronary syndrome, with improvements in both reported risk-management behaviours and long-term cardiovascular outcomes. The reduction in the composite endpoint was driven mainly by non-fatal myocardial infarction, so the result should be interpreted in light of the specific outcome components rather than as evidence of equal benefit across all components.