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Original research
A stand-alone structured educational programme after myocardial infarction: a randomised study
  1. Georgios Giannopoulos1,
  2. Sofia Karageorgiou2,
  3. Dimitrios Vrachatis2,
  4. Ioannis Anagnostopoulos1,
  5. Maria S Kousta1,
  6. Eleni Lakka1,
  7. Sotiria Giotaki2,
  8. Konstantinos Raisakis1,
  9. Georgios Sianos3,
  10. Konstantinos Toutouzas4,
  11. Michael Cleman5,
  12. Spyridon Deftereos2
  1. 1Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
  2. 22nd Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
  3. 31st Department of Cardiology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
  4. 41st Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
  5. 5Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Georgios Giannopoulos, Department of Cardiology, Athens General Hospital "G, Gennimatas", Mesogeion 154, Athens 11527, Greece; ggiann{at}


Background Acute myocardial infarction (MI) is a major clinical manifestation of coronary artery disease. Post-MI morbidity and mortality can be reduced by lifestyle changes and aggressive risk factor modification. These changes can be applied more effectively if the patient is actively involved in the process. The hypothesis of this study was that an educational programme in post-MI patients could lead to reduced incidence of cardiovascular events.

Methods Post-MI patients were prospectively randomised into two groups. Patients in the intervention arm were scheduled to attend an 8-week-long educational programme on top of usual treatment, while controls received optimal treatment. The primary endpoint was the composite of all-cause death, MI, cerebrovascular event and unscheduled hospitalisation for cardiovascular causes. Endpoint adjudication was blinded.

Results 329 patients (238 men) were included, with a mean follow-up time of 17±4 months. In the primary analysis, mean primary end point-free survival time was 597 days (95% CI 571 to 624) in controls, compared with 663 days (95% CI 638 to 687) in the intervention group (p<0.001). The HR in the univariate Cox regression analysis was 0.48 (95% CI 0.32 to 0.73; p=0.001). The raw rates of the primary endpoint were 20.8% (6 deaths, 13 MIs, 2 strokes and 14 hospitalisations) vs 36.6% (8 deaths, 22 MIs, 7 strokes and 22 hospitalisations), respectively (OR 0.46, 95% CI 0.28 to 0.74; p=0.002).

Conclusion These results suggest that a relatively short adult education programme offered to post-MI patients has beneficial effects, resulting in reduced risk of cardiovascular events.

Trial registration number NCT04007887.

  • myocardial infarction
  • cardiac rehabilitation
  • risk factors

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  • GG and SK contributed equally.

  • Contributors GG and SK contributed to planning, conduct and reporting of this study and are responsible for the overall content. DV contributed to data collection and analysis. IA, MSK, EL, SG and KR contributed to the conduct of this study. GG and SK drafted the manuscript. KT, GS, MC and SD critically reviewed and approved of the final manuscript. MC also reviewed the paper for language errors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Bioethics Committee and the Scientific Board of Attikon University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Anonymised patient-level data are available on reasonable request.

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