Nurses Can Be Pivotal in Post-ACS Secondary Prevention: ALLEPRE

CHICAGO, IL—A nurse-coordinated program for secondary prevention in patients hospitalized with acute coronary syndromes can reduce the risk of MACE over the next 7 years, the ALLEPRE trial suggests.

Giulia Magnani, MD, PhD (University of Parma, Italy), presenting the data this weekend at the American College of Cardiology (ACC) 2025 Scientific Session, stressed that ACS continues to be the “principal cause of global morbidity and mortality.”

Recurrent events can be reduced through medical therapy, lifestyle changes, and risk factor control, “but real-world evidence indicates that secondary cardiovascular prevention remains suboptimal,” she said. “The involvement of nurses in CV prevention programs have previously led to positive short-term results, but there is a lack of long-term data and measurable benefits.”

Laura Davidson, MD (Northwestern Medicine, Chicago, IL), who discussed the ALLPRE findings during an ACC press conference, agreed that ACS can be “a very devastating diagnosis” for many patients.

“It happens very suddenly. . . . [and] can warrant a lot of lifestyle changes at a very quick pace,” commented Davidson. “It’s a lot for patients to take in when they’re in the hospital and faced with this situation, in terms of making not only lifestyle changes but also medication changes.”

ALLEPRE provides evidence that, “with proper training of different types of clinicians, we can actually help these patients from the beginning of this diagnosis with secondary prevention to prevent events in the future,” she said, adding that having a dedicated team, while not inexpensive, appears to be very effective.

“It’s not just physicians that are at the forefront of helping these patients—it is a true team effort from a lot of people that are involved in these patients’ care,” said Davidson. “We should feel that we can empower nurses to take on this important role.”

It’s not just physicians that are at the forefront of helping these patients—it is a true team effort from a lot of people. Laura Davidson

ALLEPRE investigators set out to test the benefits of a nurse-coordinated prevention program among 2,057 patients hospitalized with STEMI, NSTEMI, or unstable angina at one of seven hospitals in Italy.

Patients were randomized in the hospital to either standard of care (at least three follow-up visits with their cardiologist over 5 years) or the nurse-led program (at least nine individual educational sessions with a nurse coordinator during the index hospitalization then at 1, 3, 6, 12, 24, 36, and 48 months). The sessions included CV risk profile assessment, monitoring of medication adherence, promotion of a healthy lifestyle, and referral to a multidisciplinary care team, if needed, for additional CV and psychological support.

The 250 nurses involved in the program were professional cardiology nurses working full-time at participating centers. They took part in a centralized, 3-day, in-person training course run by a team that included medical, nursing, and psychology experts. After passing the end-of-training exam, all were awarded a certificate in CV prevention.

Baseline characteristics between the two patient groups were well-balanced. Mean age was 64 years, and women made up 22% of the population. Median body mass index (BMI) was 27 kg/m², around two-thirds had hypertension or dyslipidemia, 21% had diabetes, and more than one-third were current smokers.

The primary endpoint of CV death, nonfatal MI, or nonfatal stroke at 7 years was reduced with the nurse-led program in comparison to standard care, as was the rate of nonfatal MI. For CV death and stroke, rates were numerically but not significantly higher with standard of care. Results were consistent across subgroups.

Post-ACS Hospitalization: Outcomes at 7 Years

Between baseline and last follow-up, patients who received the nurse-coordinated care saw their BMIs drop slightly (from 27.7 to 27.3 kg/m²), whereas the BMIs of those receiving standard of care held steady (P = 0.003 between groups). There were no significant differences in LDL or systolic blood pressure, and among diabetic patients there were no differences in HbA1c levels. Additionally, at final follow-up patients in the nursing-led group exercised at higher intensities, had better medication adherence, and were more likely to quit smoking.

“The benefit of the structured, intensive, nurse-coordinated prevention program emerged early and further accrued over time,” Magnani concluded, adding that the greatest impact seemed to be on lifestyle modifications. She said further study as well as a cost-effectiveness analysis are needed before implementing this approach more widely.

‘Empower the Patients’

Vera Bittner, MD (UAB Medicine, Birmingham, AL), the assigned discussant in the late-breaking trial session, said it’s “very exciting to see that the intervention . . . actually changed outcomes.”

She questioned some counterintuitive findings: medication adherence increased, for example, while LDL and BP levels did not improve. “So I would like to get your thoughts about what is driving this marked reduction [in MACE] you saw in your trial,” said Bittner.

“What we saw is that the nurse-coordinated prevention program was able, particularly, to modify behavior,” said Magnani. “As cardiologists, we know how difficult it is to modify behaviors in our patients. [It may be] that the nurse is uniquely positioned to answer some questions of the patient” as the key point of contact with care and to help with those lifestyle changes.

Bittner pointed out, too, that many patients find themselves depressed or under much stress after an MI, asking for more details on the psychological support provided.

“We are not to underestimate nontraditional cardiovascular risk factors,” Magnani said. In cases where patients were facing such challenges, the nurse could refer them to a psychological team, she explained. “The nurse was able to empower the patients with a better awareness of the disease.”