Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network.

Description

This study assessed the efficacy of an intensive rehabilitation program after myocardial infarction compared to usual care in a sample of 3,241 patients with recent myocardial infarction. Patients were randomized to a 3-year multifactorial continued educational and behavioural program (intervention group, n=1,620) or usual care (control group, n=1,621). Endpoint events occurred in 17.2% of patients. Although the intensive intervention did not decrease the primary endpoint (cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for angina pectoris), it significantly decreased several secondary endpoints [cardiovascular mortality plus nonfatal myocardial infarction and stroke (hazard ratio=0.67, 95% CI: 0.47-0.95), cardiac death plus nonfatal myocardial infarction (hazard ratio=0.64, 95% CI: 0.43-0.94), and nonfatal myocardial infarction (hazard ratio=0.52, 95% CI: 0.31-0.86)]. Moreover, a marked improvement in lifestyle habits and in prescription of drugs for secondary prevention was observed in the intervention group. These results suggest that patients might benefit from an intensive rehabilitation program after a cardiovascular event.