Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists. Ron JG Peters, MD On behalf of the RESPONSE Investigators Academic Medical Center - University of Amsterdam The Netherlands

Support Unrestricted grant from AstraZeneca, the Netherlands. No conflicts of interest

Background Secondary prevention may effectively prevent recurrent cardiovascular events. Guidelines have been issued by ESC, AHA/ACC A gap exists between these guidelines and clinical practice New, practical initiatives are needed to reduce this gap

Study design Study goal: To quantify the impact of a nurse coordinated prevention program on risk factor levels in patients with a recent coronary event

Study design Multicenter (n=11) randomised clinical trial in The Netherlands Patients: years (n=754) Discharged after ACS (unstable angina/AMI)

Study flowchart Primary outcome blinded

Primary outcome SCORE risk estimate at 12 months 10-year cardiovascular mortality – Gender & Age – Smoking status – Total cholesterol – Systolic blood pressure

Targets Nurse Intervention

Baseline characteristics

risk factors: proportion on target

Medication

5.4% Primary outcome calculated 10 year mortality (SCORE)

p= % 4.5% RR reduction 16.9% Complete attendance 93.3%

Framingham risk estimation (Secondary Outcome)

risk factors: proportion on target

Diabetes Mellitus Identified as diabetic and referred, but no diagnosis:

Classification of achievement of risk factor targets

Conclusions (1) The RESPONSE nurse coordinated prevention program resulted in lowering of cardiovascular risk in patients with a recent acute coronary event. This was achieved on top of high level usual care. Risk reduction was sustained at follow-up.

Conclusions (2) The program was effective in achieving targets for systolic blood pressure, LDL cholesterol, and healthy lifestyles. The program did not impact on weight and smoking status. Insulin resistance was highly prevalent but received insufficient attention.

Conclusions (3) The program, with up to 4 outpatient clinic visits, was well attended and feasible. The nurse coordinated prevention program can readily be implemented into daily practice.

Acknowledgements: our nurses Janine Doornenbal Annemarie von Drimmelen Harold Helmes Irma Kremer Franciska Kuijper Rob Lardinois Naomi Moerman Annie Obbema Aafje Reijenga Leon Schotman Lennie Setten van der Meer Ira van Sleeuwen Ann Klein Twennaar Eelkje Wolf Doetie van der Woude

RESPONSE study group