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

Pantaleo Giannuzzi, Pier Luigi Temporelli, Roberto Marchioli, Aldo Pietro Maggioni, Gianluigi Balestroni, Vincenzo Ceci, Carmine Chieffo, Marinella Gattone, Raffaele Griffo, Carlo Schweiger, Luigi Tavazzi, Stefano Urbinati, Franco Valagussa, Diego Vanuzzo, D. Girardini, G. Francesconi, M. Vona, R. Santoni, C. Sarno, P. CalisiM. Forzoni, L. Boncompagni, G. Tabouret, U. Canci, G. Rosato, G. Stanco, G. Gullace, C. Carbone, A. Gavazzi, D. Mazzoleni, G. Pinelli, R. Frizzelli, O. Tortelli, A. Pantaleoni, E. Mantovani, G. Pettinati, G. Storti, C. Riccio, D. Scrutinio, A. Passantino, U. Guiducci, G. Zobbi, D. Vanaria, P. Barbanti, V. Carini, R. Coco, G. Borrello, M. L. Mazza, F. Chiesa, C. Sansoni, E. Morbelli, L. Rossi, C. Ciglia, P. Di Giovanni, M. Cocchieri, V. Dò, A. Trudu, D. Albonico, S. Bendinelli, E. Iori, G. Balestra, N. Giacometti, S. Coppetti, S. Priori, G. Masotti, F. Fattirolli, L. Meniconi, P. Paolucci, C. Malinverni, F. Quarenghi, A. Fontanelli, R. Marini, S. Mandorla, M. Provvidenza, A. Giordano, F. De Giuli, L. Odoguardi, S. Barsotti, T. Moccetti, A. Molteni, F. Mauri, G. Lecchi, R. Bettini, A. Bertoldi, R. Zanettini, P. Centeleghe, S. Corallo, M. L. Rainoldi, M. Ferratini, M. Tavanelli, G. Leonetti, G. Malfatto, P. Pascotto, A. Zanocco, R. Buchberger, G. Masaro, F. Cobelli, G. Riccardi, L. Sala, G. Musca, M. A. Cauteruccio, C. Vigorito, F. Giallauria, N. Mininni, P. Morra, A. Castello, F. M. Sarullo, D. Castelli, R. Tramarin, M. De Salvo, C. Porcellati, F. Giovagnoni, P. F. Anniboletti, M. G. Calisti, W. Vergoni, L. Iacopetti, F. Zelaschi, S. D'Cruz, A. Lopizzo, M. Caiazza, G. Gigli, J. Pastine, G. Pulitanò, A. Ruggeri, G. Piovaccari, P. Semprini, G. Zavatteri, T. Diaco, V. Ceci, F. Lumia, A. M. Tamiz, G. Oliva, A. Galati, A. Picelli, F. Pesciatini, R. Bosco, G. Marcellini, E. Zanchè, G. Martin, S. Masutti, L. Milani, G. M. Pizzolato, G. Occhi, N. Partesana, N. Baldi, G. Polimeni, G. Furgi, A. Nicolino, R. Bevilacqua, B. Ingignoli, N. Massobrio, G. Avogliero, R. Pedretti, R. Vaninetti, L. Donnangelo, M. Chiatto, P. Gori, A. Fontanelli, R. Garbin

Research output: Contribution to journalArticle

249 Citations (Scopus)

Abstract

Background: Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a longterm, relatively intensive rehabilitation strategy after MI. Methods:Weconducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n=1620) or usual care (control group; n=1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results: End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR],0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion: The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration: ClinicalTrials.gov Identifier: NCT00421876.

Original languageEnglish
Pages (from-to)2194-2204
Number of pages11
JournalArchives of Internal Medicine
Volume168
Issue number20
DOIs
Publication statusPublished - Nov 10 2008

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Secondary Prevention
Multicenter Studies
Randomized Controlled Trials
Myocardial Infarction
Recurrence
Confidence Intervals
Habits
Life Style
Rehabilitation
Stroke
Cardiac Rehabilitation
Drug Prescriptions
Prescription Drugs
Mortality
Quality of Health Care
Angina Pectoris
Critical Care
Hospitalization
Heart Failure
Body Weight

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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. / Giannuzzi, Pantaleo; Temporelli, Pier Luigi; Marchioli, Roberto; Maggioni, Aldo Pietro; Balestroni, Gianluigi; Ceci, Vincenzo; Chieffo, Carmine; Gattone, Marinella; Griffo, Raffaele; Schweiger, Carlo; Tavazzi, Luigi; Urbinati, Stefano; Valagussa, Franco; Vanuzzo, Diego; Girardini, D.; Francesconi, G.; Vona, M.; Santoni, R.; Sarno, C.; Calisi, P.; Forzoni, M.; Boncompagni, L.; Tabouret, G.; Canci, U.; Rosato, G.; Stanco, G.; Gullace, G.; Carbone, C.; Gavazzi, A.; Mazzoleni, D.; Pinelli, G.; Frizzelli, R.; Tortelli, O.; Pantaleoni, A.; Mantovani, E.; Pettinati, G.; Storti, G.; Riccio, C.; Scrutinio, D.; Passantino, A.; Guiducci, U.; Zobbi, G.; Vanaria, D.; Barbanti, P.; Carini, V.; Coco, R.; Borrello, G.; Mazza, M. L.; Chiesa, F.; Sansoni, C.; Morbelli, E.; Rossi, L.; Ciglia, C.; Di Giovanni, P.; Cocchieri, M.; Dò, V.; Trudu, A.; Albonico, D.; Bendinelli, S.; Iori, E.; Balestra, G.; Giacometti, N.; Coppetti, S.; Priori, S.; Masotti, G.; Fattirolli, F.; Meniconi, L.; Paolucci, P.; Malinverni, C.; Quarenghi, F.; Fontanelli, A.; Marini, R.; Mandorla, S.; Provvidenza, M.; Giordano, A.; De Giuli, F.; Odoguardi, L.; Barsotti, S.; Moccetti, T.; Molteni, A.; Mauri, F.; Lecchi, G.; Bettini, R.; Bertoldi, A.; Zanettini, R.; Centeleghe, P.; Corallo, S.; Rainoldi, M. L.; Ferratini, M.; Tavanelli, M.; Leonetti, G.; Malfatto, G.; Pascotto, P.; Zanocco, A.; Buchberger, R.; Masaro, G.; Cobelli, F.; Riccardi, G.; Sala, L.; Musca, G.; Cauteruccio, M. A.; Vigorito, C.; Giallauria, F.; Mininni, N.; Morra, P.; Castello, A.; Sarullo, F. M.; Castelli, D.; Tramarin, R.; De Salvo, M.; Porcellati, C.; Giovagnoni, F.; Anniboletti, P. F.; Calisti, M. G.; Vergoni, W.; Iacopetti, L.; Zelaschi, F.; D'Cruz, S.; Lopizzo, A.; Caiazza, M.; Gigli, G.; Pastine, J.; Pulitanò, G.; Ruggeri, A.; Piovaccari, G.; Semprini, P.; Zavatteri, G.; Diaco, T.; Ceci, V.; Lumia, F.; Tamiz, A. M.; Oliva, G.; Galati, A.; Picelli, A.; Pesciatini, F.; Bosco, R.; Marcellini, G.; Zanchè, E.; Martin, G.; Masutti, S.; Milani, L.; Pizzolato, G. M.; Occhi, G.; Partesana, N.; Baldi, N.; Polimeni, G.; Furgi, G.; Nicolino, A.; Bevilacqua, R.; Ingignoli, B.; Massobrio, N.; Avogliero, G.; Pedretti, R.; Vaninetti, R.; Donnangelo, L.; Chiatto, M.; Gori, P.; Fontanelli, A.; Garbin, R.

In: Archives of Internal Medicine, Vol. 168, No. 20, 10.11.2008, p. 2194-2204.

Research output: Contribution to journalArticle

Giannuzzi, P, Temporelli, PL, Marchioli, R, Maggioni, AP, Balestroni, G, Ceci, V, Chieffo, C, Gattone, M, Griffo, R, Schweiger, C, Tavazzi, L, Urbinati, S, Valagussa, F, Vanuzzo, D, Girardini, D, Francesconi, G, Vona, M, Santoni, R, Sarno, C, Calisi, P, Forzoni, M, Boncompagni, L, Tabouret, G, Canci, U, Rosato, G, Stanco, G, Gullace, G, Carbone, C, Gavazzi, A, Mazzoleni, D, Pinelli, G, Frizzelli, R, Tortelli, O, Pantaleoni, A, Mantovani, E, Pettinati, G, Storti, G, Riccio, C, Scrutinio, D, Passantino, A, Guiducci, U, Zobbi, G, Vanaria, D, Barbanti, P, Carini, V, Coco, R, Borrello, G, Mazza, ML, Chiesa, F, Sansoni, C, Morbelli, E, Rossi, L, Ciglia, C, Di Giovanni, P, Cocchieri, M, Dò, V, Trudu, A, Albonico, D, Bendinelli, S, Iori, E, Balestra, G, Giacometti, N, Coppetti, S, Priori, S, Masotti, G, Fattirolli, F, Meniconi, L, Paolucci, P, Malinverni, C, Quarenghi, F, Fontanelli, A, Marini, R, Mandorla, S, Provvidenza, M, Giordano, A, De Giuli, F, Odoguardi, L, Barsotti, S, Moccetti, T, Molteni, A, Mauri, F, Lecchi, G, Bettini, R, Bertoldi, A, Zanettini, R, Centeleghe, P, Corallo, S, Rainoldi, ML, Ferratini, M, Tavanelli, M, Leonetti, G, Malfatto, G, Pascotto, P, Zanocco, A, Buchberger, R, Masaro, G, Cobelli, F, Riccardi, G, Sala, L, Musca, G, Cauteruccio, MA, Vigorito, C, Giallauria, F, Mininni, N, Morra, P, Castello, A, Sarullo, FM, Castelli, D, Tramarin, R, De Salvo, M, Porcellati, C, Giovagnoni, F, Anniboletti, PF, Calisti, MG, Vergoni, W, Iacopetti, L, Zelaschi, F, D'Cruz, S, Lopizzo, A, Caiazza, M, Gigli, G, Pastine, J, Pulitanò, G, Ruggeri, A, Piovaccari, G, Semprini, P, Zavatteri, G, Diaco, T, Ceci, V, Lumia, F, Tamiz, AM, Oliva, G, Galati, A, Picelli, A, Pesciatini, F, Bosco, R, Marcellini, G, Zanchè, E, Martin, G, Masutti, S, Milani, L, Pizzolato, GM, Occhi, G, Partesana, N, Baldi, N, Polimeni, G, Furgi, G, Nicolino, A, Bevilacqua, R, Ingignoli, B, Massobrio, N, Avogliero, G, Pedretti, R, Vaninetti, R, Donnangelo, L, Chiatto, M, Gori, P, Fontanelli, A & Garbin, R 2008, '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', Archives of Internal Medicine, vol. 168, no. 20, pp. 2194-2204. https://doi.org/10.1001/archinte.168.20.2194
Giannuzzi, Pantaleo ; Temporelli, Pier Luigi ; Marchioli, Roberto ; Maggioni, Aldo Pietro ; Balestroni, Gianluigi ; Ceci, Vincenzo ; Chieffo, Carmine ; Gattone, Marinella ; Griffo, Raffaele ; Schweiger, Carlo ; Tavazzi, Luigi ; Urbinati, Stefano ; Valagussa, Franco ; Vanuzzo, Diego ; Girardini, D. ; Francesconi, G. ; Vona, M. ; Santoni, R. ; Sarno, C. ; Calisi, P. ; Forzoni, M. ; Boncompagni, L. ; Tabouret, G. ; Canci, U. ; Rosato, G. ; Stanco, G. ; Gullace, G. ; Carbone, C. ; Gavazzi, A. ; Mazzoleni, D. ; Pinelli, G. ; Frizzelli, R. ; Tortelli, O. ; Pantaleoni, A. ; Mantovani, E. ; Pettinati, G. ; Storti, G. ; Riccio, C. ; Scrutinio, D. ; Passantino, A. ; Guiducci, U. ; Zobbi, G. ; Vanaria, D. ; Barbanti, P. ; Carini, V. ; Coco, R. ; Borrello, G. ; Mazza, M. L. ; Chiesa, F. ; Sansoni, C. ; Morbelli, E. ; Rossi, L. ; Ciglia, C. ; Di Giovanni, P. ; Cocchieri, M. ; Dò, V. ; Trudu, A. ; Albonico, D. ; Bendinelli, S. ; Iori, E. ; Balestra, G. ; Giacometti, N. ; Coppetti, S. ; Priori, S. ; Masotti, G. ; Fattirolli, F. ; Meniconi, L. ; Paolucci, P. ; Malinverni, C. ; Quarenghi, F. ; Fontanelli, A. ; Marini, R. ; Mandorla, S. ; Provvidenza, M. ; Giordano, A. ; De Giuli, F. ; Odoguardi, L. ; Barsotti, S. ; Moccetti, T. ; Molteni, A. ; Mauri, F. ; Lecchi, G. ; Bettini, R. ; Bertoldi, A. ; Zanettini, R. ; Centeleghe, P. ; Corallo, S. ; Rainoldi, M. L. ; Ferratini, M. ; Tavanelli, M. ; Leonetti, G. ; Malfatto, G. ; Pascotto, P. ; Zanocco, A. ; Buchberger, R. ; Masaro, G. ; Cobelli, F. ; Riccardi, G. ; Sala, L. ; Musca, G. ; Cauteruccio, M. A. ; Vigorito, C. ; Giallauria, F. ; Mininni, N. ; Morra, P. ; Castello, A. ; Sarullo, F. M. ; Castelli, D. ; Tramarin, R. ; De Salvo, M. ; Porcellati, C. ; Giovagnoni, F. ; Anniboletti, P. F. ; Calisti, M. G. ; Vergoni, W. ; Iacopetti, L. ; Zelaschi, F. ; D'Cruz, S. ; Lopizzo, A. ; Caiazza, M. ; Gigli, G. ; Pastine, J. ; Pulitanò, G. ; Ruggeri, A. ; Piovaccari, G. ; Semprini, P. ; Zavatteri, G. ; Diaco, T. ; Ceci, V. ; Lumia, F. ; Tamiz, A. M. ; Oliva, G. ; Galati, A. ; Picelli, A. ; Pesciatini, F. ; Bosco, R. ; Marcellini, G. ; Zanchè, E. ; Martin, G. ; Masutti, S. ; Milani, L. ; Pizzolato, G. M. ; Occhi, G. ; Partesana, N. ; Baldi, N. ; Polimeni, G. ; Furgi, G. ; Nicolino, A. ; Bevilacqua, R. ; Ingignoli, B. ; Massobrio, N. ; Avogliero, G. ; Pedretti, R. ; Vaninetti, R. ; Donnangelo, L. ; Chiatto, M. ; Gori, P. ; Fontanelli, A. ; Garbin, R. / 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. In: Archives of Internal Medicine. 2008 ; Vol. 168, No. 20. pp. 2194-2204.
@article{02c2a7db5fb5432b82844ea411cb01f3,
title = "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",
abstract = "Background: Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a longterm, relatively intensive rehabilitation strategy after MI. Methods:Weconducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n=1620) or usual care (control group; n=1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results: End point events occurred in 556 patients (17.2{\%}). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1{\%} vs 18.2{\%}; hazard ratio [HR],0.88; 95{\%} confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2{\%} vs 4.8{\%}; HR, 0.67; 95{\%} CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5{\%} vs 4.0{\%}; HR, 0.64; 95{\%} CI, 0.43-0.94), and nonfatal MI (1.4{\%} vs 2.7{\%}; HR, 0.52; 95{\%} CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion: The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration: ClinicalTrials.gov Identifier: NCT00421876.",
author = "Pantaleo Giannuzzi and Temporelli, {Pier Luigi} and Roberto Marchioli and Maggioni, {Aldo Pietro} and Gianluigi Balestroni and Vincenzo Ceci and Carmine Chieffo and Marinella Gattone and Raffaele Griffo and Carlo Schweiger and Luigi Tavazzi and Stefano Urbinati and Franco Valagussa and Diego Vanuzzo and D. Girardini and G. Francesconi and M. Vona and R. Santoni and C. Sarno and P. Calisi and M. Forzoni and L. Boncompagni and G. Tabouret and U. Canci and G. Rosato and G. Stanco and G. Gullace and C. Carbone and A. Gavazzi and D. Mazzoleni and G. Pinelli and R. Frizzelli and O. Tortelli and A. Pantaleoni and E. Mantovani and G. Pettinati and G. Storti and C. Riccio and D. Scrutinio and A. Passantino and U. Guiducci and G. Zobbi and D. Vanaria and P. Barbanti and V. Carini and R. Coco and G. Borrello and Mazza, {M. L.} and F. Chiesa and C. Sansoni and E. Morbelli and L. Rossi and C. Ciglia and {Di Giovanni}, P. and M. Cocchieri and V. D{\`o} and A. Trudu and D. Albonico and S. Bendinelli and E. Iori and G. Balestra and N. Giacometti and S. Coppetti and S. Priori and G. Masotti and F. Fattirolli and L. Meniconi and P. Paolucci and C. Malinverni and F. Quarenghi and A. Fontanelli and R. Marini and S. Mandorla and M. Provvidenza and A. Giordano and {De Giuli}, F. and L. Odoguardi and S. Barsotti and T. Moccetti and A. Molteni and F. Mauri and G. Lecchi and R. Bettini and A. Bertoldi and R. Zanettini and P. Centeleghe and S. Corallo and Rainoldi, {M. L.} and M. Ferratini and M. Tavanelli and G. Leonetti and G. Malfatto and P. Pascotto and A. Zanocco and R. Buchberger and G. Masaro and F. Cobelli and G. Riccardi and L. Sala and G. Musca and Cauteruccio, {M. A.} and C. Vigorito and F. Giallauria and N. Mininni and P. Morra and A. Castello and Sarullo, {F. M.} and D. Castelli and R. Tramarin and {De Salvo}, M. and C. Porcellati and F. Giovagnoni and Anniboletti, {P. F.} and Calisti, {M. G.} and W. Vergoni and L. Iacopetti and F. Zelaschi and S. D'Cruz and A. Lopizzo and M. Caiazza and G. Gigli and J. Pastine and G. Pulitan{\`o} and A. Ruggeri and G. Piovaccari and P. Semprini and G. Zavatteri and T. Diaco and V. Ceci and F. Lumia and Tamiz, {A. M.} and G. Oliva and A. Galati and A. Picelli and F. Pesciatini and R. Bosco and G. Marcellini and E. Zanch{\`e} and G. Martin and S. Masutti and L. Milani and Pizzolato, {G. M.} and G. Occhi and N. Partesana and N. Baldi and G. Polimeni and G. Furgi and A. Nicolino and R. Bevilacqua and B. Ingignoli and N. Massobrio and G. Avogliero and R. Pedretti and R. Vaninetti and L. Donnangelo and M. Chiatto and P. Gori and A. Fontanelli and R. Garbin",
year = "2008",
month = "11",
day = "10",
doi = "10.1001/archinte.168.20.2194",
language = "English",
volume = "168",
pages = "2194--2204",
journal = "Archives of Internal Medicine",
issn = "0003-9926",
publisher = "American Medical Association",
number = "20",

}

TY - JOUR

T1 - Global secondary prevention strategies to limit event recurrence after myocardial infarction

T2 - Results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network

AU - Giannuzzi, Pantaleo

AU - Temporelli, Pier Luigi

AU - Marchioli, Roberto

AU - Maggioni, Aldo Pietro

AU - Balestroni, Gianluigi

AU - Ceci, Vincenzo

AU - Chieffo, Carmine

AU - Gattone, Marinella

AU - Griffo, Raffaele

AU - Schweiger, Carlo

AU - Tavazzi, Luigi

AU - Urbinati, Stefano

AU - Valagussa, Franco

AU - Vanuzzo, Diego

AU - Girardini, D.

AU - Francesconi, G.

AU - Vona, M.

AU - Santoni, R.

AU - Sarno, C.

AU - Calisi, P.

AU - Forzoni, M.

AU - Boncompagni, L.

AU - Tabouret, G.

AU - Canci, U.

AU - Rosato, G.

AU - Stanco, G.

AU - Gullace, G.

AU - Carbone, C.

AU - Gavazzi, A.

AU - Mazzoleni, D.

AU - Pinelli, G.

AU - Frizzelli, R.

AU - Tortelli, O.

AU - Pantaleoni, A.

AU - Mantovani, E.

AU - Pettinati, G.

AU - Storti, G.

AU - Riccio, C.

AU - Scrutinio, D.

AU - Passantino, A.

AU - Guiducci, U.

AU - Zobbi, G.

AU - Vanaria, D.

AU - Barbanti, P.

AU - Carini, V.

AU - Coco, R.

AU - Borrello, G.

AU - Mazza, M. L.

AU - Chiesa, F.

AU - Sansoni, C.

AU - Morbelli, E.

AU - Rossi, L.

AU - Ciglia, C.

AU - Di Giovanni, P.

AU - Cocchieri, M.

AU - Dò, V.

AU - Trudu, A.

AU - Albonico, D.

AU - Bendinelli, S.

AU - Iori, E.

AU - Balestra, G.

AU - Giacometti, N.

AU - Coppetti, S.

AU - Priori, S.

AU - Masotti, G.

AU - Fattirolli, F.

AU - Meniconi, L.

AU - Paolucci, P.

AU - Malinverni, C.

AU - Quarenghi, F.

AU - Fontanelli, A.

AU - Marini, R.

AU - Mandorla, S.

AU - Provvidenza, M.

AU - Giordano, A.

AU - De Giuli, F.

AU - Odoguardi, L.

AU - Barsotti, S.

AU - Moccetti, T.

AU - Molteni, A.

AU - Mauri, F.

AU - Lecchi, G.

AU - Bettini, R.

AU - Bertoldi, A.

AU - Zanettini, R.

AU - Centeleghe, P.

AU - Corallo, S.

AU - Rainoldi, M. L.

AU - Ferratini, M.

AU - Tavanelli, M.

AU - Leonetti, G.

AU - Malfatto, G.

AU - Pascotto, P.

AU - Zanocco, A.

AU - Buchberger, R.

AU - Masaro, G.

AU - Cobelli, F.

AU - Riccardi, G.

AU - Sala, L.

AU - Musca, G.

AU - Cauteruccio, M. A.

AU - Vigorito, C.

AU - Giallauria, F.

AU - Mininni, N.

AU - Morra, P.

AU - Castello, A.

AU - Sarullo, F. M.

AU - Castelli, D.

AU - Tramarin, R.

AU - De Salvo, M.

AU - Porcellati, C.

AU - Giovagnoni, F.

AU - Anniboletti, P. F.

AU - Calisti, M. G.

AU - Vergoni, W.

AU - Iacopetti, L.

AU - Zelaschi, F.

AU - D'Cruz, S.

AU - Lopizzo, A.

AU - Caiazza, M.

AU - Gigli, G.

AU - Pastine, J.

AU - Pulitanò, G.

AU - Ruggeri, A.

AU - Piovaccari, G.

AU - Semprini, P.

AU - Zavatteri, G.

AU - Diaco, T.

AU - Ceci, V.

AU - Lumia, F.

AU - Tamiz, A. M.

AU - Oliva, G.

AU - Galati, A.

AU - Picelli, A.

AU - Pesciatini, F.

AU - Bosco, R.

AU - Marcellini, G.

AU - Zanchè, E.

AU - Martin, G.

AU - Masutti, S.

AU - Milani, L.

AU - Pizzolato, G. M.

AU - Occhi, G.

AU - Partesana, N.

AU - Baldi, N.

AU - Polimeni, G.

AU - Furgi, G.

AU - Nicolino, A.

AU - Bevilacqua, R.

AU - Ingignoli, B.

AU - Massobrio, N.

AU - Avogliero, G.

AU - Pedretti, R.

AU - Vaninetti, R.

AU - Donnangelo, L.

AU - Chiatto, M.

AU - Gori, P.

AU - Fontanelli, A.

AU - Garbin, R.

PY - 2008/11/10

Y1 - 2008/11/10

N2 - Background: Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a longterm, relatively intensive rehabilitation strategy after MI. Methods:Weconducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n=1620) or usual care (control group; n=1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results: End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR],0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion: The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration: ClinicalTrials.gov Identifier: NCT00421876.

AB - Background: Secondary prevention is not adequately implemented after myocardial infarction (MI). We assessed the effect on quality of care and prognosis of a longterm, relatively intensive rehabilitation strategy after MI. Methods:Weconducted a multicenter, randomized controlled trial in patients following standard post-MI cardiac rehabilitation, comparing a long-term, reinforced, multifactorial educational and behavioral intervention with usual care. A total of 3241 patients with recent MI were randomized to a 3-year multifactorial continued educational and behavioral program (intervention group; n=1620) or usual care (control group; n=1621). The combination of cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, and hospitalization for angina pectoris, heart failure, or urgent revascularization procedure was the primary end point. Other end points were major CV events, major cardiac and cerebrovascular events, lifestyle habits, and drug prescriptions. Results: End point events occurred in 556 patients (17.2%). Compared with usual care, the intensive intervention did not decrease the primary end point significantly (16.1% vs 18.2%; hazard ratio [HR],0.88; 95% confidence interval [CI], 0.74-1.04). However, the intensive intervention decreased several secondary end points: CV mortality plus nonfatal MI and stroke (3.2% vs 4.8%; HR, 0.67; 95% CI, 0.47-0.95), cardiac death plus nonfatal myocardial infarction (2.5% vs 4.0%; HR, 0.64; 95% CI, 0.43-0.94), and nonfatal MI (1.4% vs 2.7%; HR, 0.52; 95% CI, 0.31-0.86). A marked improvement in lifestyle habits (ie, exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group. Conclusion: The GOSPEL Study is the first trial to our knowledge to demonstrate that a multifactorial, continued reinforced intervention up to 3 years after rehabilitation following MI is effective in decreasing the risk of several important CV outcomes, particularly nonfatal MI, although the overall effect is small. Trial Registration: ClinicalTrials.gov Identifier: NCT00421876.

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U2 - 10.1001/archinte.168.20.2194

DO - 10.1001/archinte.168.20.2194

M3 - Article

C2 - 19001195

AN - SCOPUS:55949131824

VL - 168

SP - 2194

EP - 2204

JO - Archives of Internal Medicine

JF - Archives of Internal Medicine

SN - 0003-9926

IS - 20

ER -