Patients who were counseled on heart medications and lifestyle modifications by specially trained nurses were 30% less likely to experience cardiovascular death, heart attack or stroke five years after being hospitalized for acute coronary syndrome (ACS) compared with those who received standard care, according to a study presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).

ACS, which includes heart attacks and other conditions in which blood flow to the heart is suddenly blocked, is the primary driver of illnesses and deaths from heart disease. Medications along with lifestyle and risk factor modifications such as eating a heart healthy diet, being physically active, quitting smoking and losing excess weight are proven to reduce the risk of subsequent cardiac events after ACS, but many patients find it challenging to keep up with their medications and sustain these lifestyle changes.

To help address this challenge, health care systems are increasingly looking to nurses to play a more active role in secondary prevention of subsequent events. This trial, conducted in Italy, is the first and largest to assess a nurse-led cardiology intervention for an extended follow-up period.

“There is a growing need for innovative, patient-centered, personalized medicine models that can mitigate the fragmentation of health care services,” said Giulia Magnani, MD, a cardiologist at Parma University Hospital in Parma, Italy, and the study’s first author. “Shifting cardiovascular risk assessment from physicians to other health care professionals may be a sustainable [way to enhance] the effectiveness and accessibility of care for secondary cardiovascular prevention.”

The trial enrolled 2,057 patients treated for ACS at seven hospitals in Italy. Half of the patients received nurse-led follow-up and half received standard care. For the nurse-led follow-up, patients had at least nine one-on-one sessions with a nurse coordinator starting while they were hospitalized for ACS and at one, three, six, 12, 18, 24, 36 and 48 months after discharge. Patients assigned to standard care followed the usual protocol for their treating hospital, which included at least three follow-up visits with their cardiologist over five years following their ACS hospitalization.

The nurses involved in the program received three days of specialized in-person training to earn a certificate in cardiology secondary prevention. During each visit, nurses met with patients and their caregivers to assess cardiovascular risk factors, check medication adherence and encourage lifestyle modifications. When needed, the nurses also referred patients to a multidisciplinary care team for additional cardiovascular and psychological support.

At five years, the rate of cardiovascular death, non-fatal heart attack or non-fatal stroke, the study’s primary composite endpoint, was 30% lower among patients receiving nurse-led follow-up care. This was primarily driven by a significant reduction in non-fatal heart attacks. Rates of cardiovascular death or stroke were numerically lower among patients receiving nurse-led care but the difference between groups was not statistically significant for these endpoints.

Patients receiving nurse-led follow-up showed significant improvements in physical activity and medication adherence, as well as a reduction in body mass index compared with those who received standard care. However, there was no difference between groups in terms of smoking cessation or low-density lipoprotein (LDL) cholesterol.

Nurses are well-positioned to influence behavioral change, and these findings support an enhanced role for nurses in coordinating cardiology follow-up care, the researchers said.

“Nurses are very important, because they are often the first point of contact for patients and their caregivers. Patients often feel more comfortable talking with a nurse about lifestyle modification. As cardiologists, we do very well with treating the disease with drugs, but we are not as good with changing behaviors, which is the hardest part,” Magnani said.

Although the study was limited to centers in Italy, Magnani said that the nurse training program is repeatable and validated and could be implemented in other countries, especially in the United States and United Kingdom where advanced practice providers already play an important role in cardiology care.

Since the trial was conducted in part during the COVID-19 pandemic, there were some delays in scheduling follow-up visits at the intended frequency for some patients. There were also differences in the standard care protocols between participating hospitals, reflecting the variability seen in real-world care. The researchers plan to analyze the cost effectiveness of the nurse-led intervention strategy next.

The first phase of this trial was supported by a grant from Emilia-Romagna’s regional government; the second phase has benefited from a financial contribution made by AstraZeneca.

ACC.25 will take place March 29-31, 2025, in Chicago, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC25 for the latest news from the meeting.

The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at ACC.org.