Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
How effective are intensive prevention programs after myocardial infarction in elderly patients?
A. Fach1, S. Rühle2, T. Retzlaff1, H. Kerniss1, L. A. Mata Marín1, R. Osteresch1, K. Diehl1, R. Hambrecht3, H. Wienbergen4
1Klinik für Kardiologie und Angiologie, Klinikum Links der Weser, Bremen; 2Klinik für Innere Medizin II, Klinikum Links der Weser, Bremen; 3Innere Medizin I, Klinikum Links der Weser, Bremen; 4Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen;

Background: Robust data exists on the efficacy of prevention in elderly patients (pts.). These data generate evidence on physical activity in reducing immobility, rate of falls and cognitive decline as well as on lipid lowering for reduction of cardiovascular events. Unfortunately risk factor control in this special population is poor in large European registries. It was the purpose of the present study to analyze, if intensive prevention programs (IPPs) coordinated by non-physician prevention assistants (PAs) improve risk factor control in elderly pts. with myocardial infarction (MI).

Methods: A subanalysis of the multicenter randomized IPP trial (2014-2019) and the ongoing NET-IPP trial was performed to compare the effects of IPPs in elderly pts. with younger pts.. Both trials included patients with MI and investigated long-term prevention programs with educational sessions, telephone visits and telemetric risk factor control. 

Results: Out of a total of 420 pts. eligible for participation in the IPP trial, only 74% (median age 56,5±9,7 years) agreed informed consent. Pts. that rejected study participation were significantly younger (median age 53,2±8,7a; p<0,05). 

The prevention programs of the IPP and the NET-IPP trial led to significant improvements in lipid profile and leisure-time physical activity regardless of age (table 1). 

 

0 MONTH

 

12 MONTH

P-VALUE

IPP TRIAL, PTS ≤ 59 YEARS

 

 

 

LDL (MG/DL)

140,4±41

68±22

<0,001

HDL (MG/DL)

43±10

50±15

<0,001

LEISURE-TIME PHYSICAL ACTIVITY (KCAL/WEEK)

815

1998

<0,001

 

 

 

 

IPP TRIAL, PTS ≥ 60 YEARS

 

 

 

LDL (MG/DL)

115±41

67±21

<0,001

HDL (MG/DL)

50±15

51±15

0,849

LEISURE-TIME PHYSICAL ACTIVITY (KCAL/WEEK)

1074

1988

0,01

 

 

 

 

NET-IPP TRIAL, PTS ≤59 YEARS

 

 

 

LDL (MG/DL)

114±36

57±24

<0,001

HDL (MG/DL)

45±12

53±14

<0,001

LEISURE-TIME PHYSICAL ACTIVITY (KCAL/WEEK)

712

1416

<0,001

 

 

 

 

NET-IPP TRIAL, PTS ≥60 YEARS

 

 

 

LDL (MG/DL)

113±39

57±20

<0,001

HDL (MG/DL)

46±13

56±16

<0,001

LEISURE-TIME PHYSICAL ACTIVITY (KCAL/WEEK)

453

1304

  0,002

Table 1: IPP and NET-IPP trial, pts. with prevention program, baseline vs. 12-month visit

At 12-month visit, levels of LDL-cholesterol, HDL-cholesterol and leisure-time physical activity were not significantly different between pts. ≤59 years and pts. ≥60 years in both trials. 


Conclusion: Elderly pts. with MI were more likely to participate in the prevention programs and achieved similar results compared to younger pts.. Our data demonstrate the effectivity and the importance of the implementation of intensive prevention programs coordinated by PAs regardless of patient’s age.

 
https://dgk.org/kongress_programme/jt2023/aP2066.html