Effect of an assisted self-management program to prevent new life-threatening events post heart attack

The SPAN intervention is a flexible framework for secondary prevention after a heart attack providing a minimum level of health service standardisation. It can be delivered across any health area service regardless of a patient’s age, gender, ethnicity, geographical location or socioeconomic position. Patients continue to receive their routine care, including usual pharmacotherapy and lifestyle advice at the discretion of their treating clinicians, whilst receiving the four preventative pillars of education, assessment, individual risk management planning, and supplementary follow-up. Study materials will be adapted from earlier trials (CHOICE Trial Redfern et al, Heart 2008 Sydney University ANZAC Research Institute, Concord Hospital ISRCTN42984084; CHOICE+ Neubeck et al, HLC 2018, Sydney University, ANZAC Research Institute, Concord Hospital, ACTRN12608000182392) to reflect advances in remote monitoring and technology. Use of these resources and associated intensity is at the discretion of the participant. There is no pre-specified template for the number or duration of sessions or the timing as to when they occur in the 12 weeks. The format of delivery is precision-tailored content, with setting and method of contact depending on patient need, access, preference and goals. Each patient will work with a study trained secondary prevention health professional to develop a mutually agreed schedule of contacts, strategies and goals for their personal preventive care. This is bookended by induction - mean 50 minutes - and close-out clinic visit/telephone calls - mean 30 minutes. At induction, participants are familiarised with their modifiable risk factors for new events and the options available for management should they elect to do so. All baseline data for the study will be collected at this time. At close-out, a review of the participants performance against the agreed schedule at baseline will take place. In between, patients will receive lipid-lowering and evidence-based medications (subject to contraindication and intolerance) and optional choice of additional content covering disease progression, lifestyle education, psychosocial support, and information to assist in addressing risk factors such as elevated blood pressure, raised cholesterol, physical inactivity and cigarette smoking. Further, participants can elect to engage in up to a median of 3 x 20-minute (range 5-35 minutes) phone calls with the secondary prevention coordinator to monitor progress. The intervention will commence within 2-4 weeks of leaving hospital and provides a median of 3 contacts (range 1-5) over 12 weeks. The expected overall time spent on telephone follow-up will range from 5-105 minutes with a median of 30 minutes per participant. Adherence to the intervention will be assessed during the close-out visit based on the number of ‘activities’ completed and scheduled calls that took place, compared to what was scheduled in the personalised rehabilitation plan developed by the patient and secondary prevention coordinator during the induction visit.