Can structured nurse-led care improve long-term cardiovascular outcomes after acute coronary syndrome (ACS)? The ALLiance for sEcondary PREvention after an acute coronary syndrome (ALLEPRE) trial, published in the European Heart Journal, evaluated this question in a pragmatic, multicentre, randomized design comparing a nurse-coordinated prevention program (NCPP) with standard of care (SOC) in patients following ACS.

A total of 2,057 patients were randomized 1:1 to NCPP (n=1,031) or SOC (n=1,026). The intervention included nine individualized educational sessions over four years, delivered by centrally trained nurses, focusing on cardiovascular (CV) risk factor identification, lifestyle modification, and medication adherence, while SOC followed routine institutional practice. The primary endpoint was major adverse cardiovascular events (MACE), defined as CV death, non-fatal myocardial infarction (MI), or non-fatal stroke.

Over long-term follow-up, NCPP significantly reduced MACE compared with SOC (16.2% vs 22.6%; hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.57 to 0.85; P <0.001), with the effect mainly driven by a reduction in non-fatal MI (9.3% vs 15.2%; HR 0.60; 95% CI 0.46 to 0.77; P=0.0001). The composite of MACE plus ischemia-driven revascularization was also lower (HR 0.77; 95% CI 0.64 to 0.92; P=0.005). Improvements in exercise frequency (P <0.0001), body weight control (P=0.003), and medication adherence (P <0.001) were greater with NCPP.

In this randomized trial, a nurse-coordinated prevention program reduced long-term cardiovascular events and improved lifestyle and adherence measures after ACS.