SECONDARY PREVENTION AFTER ACUTE MYOCARDIAL-INFARCTION

The hypothesis that 6 months after acute myocardial infarction, adopti on of secondary prevention activities would be higher, quality of life better, and blood cholesterol lower in patients randomly allocated to a mail-out intervention program than in those receiving usual care wa s tested. Patients were aged < 70 years, admitted to hospitals in and around Newcastle, Australia with a suspected heart attack and discharg ed alive from the hospital. Cluster randomization, based on the patien t's family practitioner, was used to allocate consenting patients to a n intervention or usual care group. A low-cost mail-out program was de signed to help patients reduce dietary fat, obtain regular exercise by walking and (for smokers only) to quit smoking. Supplementary telepho ne contact was also used. In addition, a letter was sent to the family doctor regarding the benefit of aspirin and beta blockers for seconda ry prevention. Of eligible patients, 71% participated, and 79% of the 213 intervention subjects and 87% of the 237 usual care ones returned a 6-month follow-up questionnaire. Self-reported fat intake was signif icantly lower, an ''emotional'' score obtained from a quality-of-life questionnaire was significantly higher in the intervention than in the usual care group, and ''physical'' and ''social'' scores for quality of life were slightly higher. Blood cholesterol level and other variab les were not different between the groups at 6 months. Simple low-cost programs providing support and advice on lifestyle change may be bene ficial, particularly in improving patients' perceived quality of life.