Phone-based, nurse-led follow-up interventions improve outcomes in acute coronary syndrome

A nurse-led, telephone-based follow-up intervention yields significant improvements in blood pressure (BP) and lipid profile in acute coronary syndrome (ACS) patients, a recent trial has found.

A total of 797 patients were randomized to receive either the intervention (n=406, mean age 67.3±10.7 years, 27.6 percent women) or a control (n=391, mean age 68.4±10.9 years, 29.7 percent women). The nurse-led intervention involved phone counselling and medical titration, with a BP target of <140/<90 mmHg and a low-density lipoprotein cholesterol (LDL-C) target of <2.5/<1.8 mmol/L. The primary outcome was LDL-C at 36 months.

At follow-up, the mean adjusted systolic BP was 133.5 and 129.4 mm Hg in the control and intervention groups, respectively. The resulting absolute difference of 4.1 mm Hg was statistically significant (p<0.001). A similar effect was reported for diastolic BP, with a mean difference of 2.9 mm Hg (p<0.001).

The average LDL-C levels at 36 months were 2.42 and 2.14 mmol/L in the control and intervention groups, respectively, likewise corresponding to a statistically significant difference (0.28 mmol/L; p<0.001).

Looking at temporal changes, the researchers found that the control group saw a nonsignificant increase of 1.2 and 1.2 mm Hg in systolic and diastolic BP, respectively, and of 0.21 mmol/L in LDL-C. In contrast, patients who received the intervention experienced a significant decrease of 2.2 mm Hg in systolic BP and nonsignificant reductions of 1.1 mm Hg and 0.017 mmol/L in diastolic BP and LDL-C, respectively.

“Our data imply that a secondary prevention strategy must be sustained beyond the first year to maintain risk factor reduction,” the researchers said.