{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:59:49Z","timestamp":1771919989862,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Catalan Health Service","award":["PT-022023-EP_DAIPO"],"award-info":[{"award-number":["PT-022023-EP_DAIPO"]}]},{"name":"Novartis"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Despite advances in the management of acute coronary syndrome (ACS), women continue to experience higher long-term mortality and lower access to secondary prevention compared with men. Objective: This study aimed to assess whether a universally inclusive, nurse-led secondary prevention program implemented at a University Hospital improved post-ACS outcomes and reduced gender disparities in risk factor control and mortality. Methods: This retrospective, observational study compared two cohorts of ACS survivors discharged from Bellvitge University Hospital: a pre-intervention cohort (2018) and a post-intervention cohort (2022). The nurse-led program included universal enrollment of all ACS patients, early follow-up, pharmacological optimization, therapeutic exercise, lifestyle counseling, and coordination with primary care. Outcomes included lipid and glycemic control and 18-month mortality, stratified by sex. Results: A total of 409 patients were included (2018: n = 200; 2022: n = 209), of whom 130 were women. Women were older and had more comorbidities. Post-program implementation, the proportion of patients without post-discharge blood testing dropped from &gt;50% to &lt;17% in both sexes. Lipid and glycemic control improved significantly at both early (1\u20134 months) and late (9\u201318 months) follow-up. Early differences favoring men disappeared by 18 months. Mortality decreased by 27.5% in men and 47.6% in women, representing a significantly greater relative reduction among women (p = 0.0001). Conclusions: A structured, nurse-led secondary prevention program with systematic inclusion improved clinical outcomes and significantly narrowed the gender gap in cardiovascular mortality. These findings demonstrate that equitable, protocolized care led by advanced practice nurses can reduce systemic inequities in cardiovascular health.<\/jats:p>","DOI":"10.3390\/jcdd13020102","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T08:58:21Z","timestamp":1771837101000},"page":"102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nurse-Led Secondary Prevention After Acute Coronary Syndrome: Bridging the Gender Gap in Cardiovascular Outcomes\u2014A Sub-Analysis of the BEAT-HF Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2299-4750","authenticated-orcid":false,"given":"Oona","family":"Mero\u00f1o Due\u00f1as","sequence":"first","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"},{"name":"Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L\u2019Hospitalet de Llobregat, Spain"},{"name":"School of Medicine, Universitat de Vic-Central de Catalunya, 08500 Vic, Spain"},{"name":"Ciber Cardiovascular Group (CIBER-CV), Instituto Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar Iraculis","family":"Sanchez","sequence":"additional","affiliation":[{"name":"School of Medicine, Universitat de Vic-Central de Catalunya, 08500 Vic, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Llagostera Martin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"},{"name":"Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Ruiz Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Gomez Cuba","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laia","family":"Alcober Morte","sequence":"additional","affiliation":[{"name":"Primary Care Management and The Delta and Baix Llobregat Community, GAPiC Delta, Institut Catala de la Salut, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2161-6437","authenticated-orcid":false,"given":"Natalia L\u00f3pez","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Evaluation Unit, Department of Data Management, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillem","family":"Cirera Salleras","sequence":"additional","affiliation":[{"name":"Evaluation Unit, Department of Data Management, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1985-0377","authenticated-orcid":false,"given":"Adrian","family":"Ricarte Marin","sequence":"additional","affiliation":[{"name":"Evaluation Unit, Department of Data Management, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Soler","family":"Cera","sequence":"additional","affiliation":[{"name":"Evaluation Unit, Department of Data Management, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Garay Melero","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Simo Cubel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3249-3095","authenticated-orcid":false,"given":"Joan Antoni","family":"Gomez Hospital","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bellvitge University Hospital\u2014Bellvitge Biomedical Research Institute (IDIBELL), 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Capdevila Aguilera","sequence":"additional","affiliation":[{"name":"Department of Gerence, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8780-720X","authenticated-orcid":false,"given":"Josep","family":"Comin Colet","sequence":"additional","affiliation":[{"name":"Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L\u2019Hospitalet de Llobregat, Spain"},{"name":"Ciber Cardiovascular Group (CIBER-CV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), 08036 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, 08907 L\u2019Hospitalet de Llobregat, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2023). The Top 10 Causes of Death, WHO. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","first-page":"11","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"11","author":"Dibben","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Woodward, M. (2019). Cardiovascular Disease and the Female Disadvantage. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16071165"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cardeillac, M., Lefebvre, F., Baicry, F., Le Borgne, P., Gil-Jardin\u00e9, C., Cipolat, L., Peschanski, N., and Vuillaume, L.A. (2022). Symptoms of Infarction in Women: Is There a Real Difference Compared to Men? A Systematic Review of Literature with Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11051319"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"oeae087","DOI":"10.1093\/ehjopen\/oeae087","article-title":"Call to action for acute myocardial infarction in women: International multi-disciplinary practical roadmap","volume":"4","author":"Hawranek","year":"2024","journal-title":"Eur. Heart J. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.tcm.2017.02.005","article-title":"The role of cardiac rehabilitation in patients with heart disease","volume":"27","author":"McMahon","year":"2017","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1161\/CIRCRESAHA.121.319894","article-title":"Sex Differences in Cardiac Rehabilitation Outcomes","volume":"130","author":"Smith","year":"2022","journal-title":"Circ. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Firoozabadi, M.G., Mirzaei, M., Grace, S.L., Vafaeinasab, M., Dehghani-Tafti, M., Sadeghi, A., Asadi, Z., and Basirinezhad, M.H. (2023). Sex differences in cardiac rehabilitation barriers among non-enrollees in the context of lower gender equality: A cross-sectional study. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03331-7"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s12939-024-02230-3","article-title":"Gender inequalities in secondary prevention of cardiovascular disease: A scoping review","volume":"23","author":"Ferreruela","year":"2024","journal-title":"Int. J. Equity Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1161\/CIR.0000000000000351","article-title":"Acute Myocardial Infarction in Women: A Scientific Statement from the American Heart Association","volume":"133","author":"Mehta","year":"2016","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.recesp.2021.05.009","article-title":"Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality","volume":"75","author":"Rossello","year":"2022","journal-title":"Rev. Espa\u00f1ola Cardiol."},{"key":"ref_14","first-page":"200276","article-title":"Sex and gender differences in patients with acute coronary syndromes","volume":"21","author":"Pratesi","year":"2024","journal-title":"Int. J. Cardiol. Cardiovasc. Risk Prev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.tcm.2025.07.007","article-title":"Italian Society of Cardiology Working Group on Gender Cardiovascular Diseases. Gender and Sex-related differences in Type 2 Myocardial Infarction: The undervalued side of a neglected disease","volume":"36","author":"Angeli","year":"2026","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_16","first-page":"e43482","article-title":"Analysis of Gender-Based Inequality in Cardiovascular Health: An Umbrella Review","volume":"15","author":"Bosomworth","year":"2023","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.mayocp.2017.01.002","article-title":"Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions","volume":"92","author":"Yeung","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1161\/CIR.0000000000000019","article-title":"American Heart Association Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: Systematic review and recommendations: A scientific statement from the American Heart Association","volume":"129","author":"Lichtman","year":"2014","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Chong, R.J., Hao, Y., Tan, E.W.Q., Mok, G.J.L., Sia, C.H., Ho, J.S.Y., Chan, M.Y.Y., and Ho, A.F.W. (2025). Prevalence of Depression, Anxiety and Post-Traumatic Stress Disorder (PTSD) After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061786"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.atherosclerosis.2014.01.012","article-title":"Depression symptoms and the progression of carotid intima-media thickness: A 5-year follow-up study","volume":"233","author":"Pizzi","year":"2014","journal-title":"Atherosclerosis"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1093\/eurjpc\/zwaa144","article-title":"Gender gap in risk factor control of coronary patients far from closing: Results from the European Society of Cardiology EUROASPIRE V registry","volume":"29","author":"Vynckier","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.ijcard.2022.09.010","article-title":"Gender differences in health-related quality of life and psychological distress among coronary patients: Does comorbidity matter? Results from the ESC EORP EUROASPIRE V registry","volume":"371","author":"Vynckier","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Malo, S., Maldonado, L., Rabanaque, M.J., Bengoa-Urrengoechea, I., Castel-Feced, S., S\u00e1nchez-Calavera, M.A., and Aguilar-Palacio, I. (2025). Primary care utilisation in different patients\u2019 profiles with cardiovascular risk factors. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-024-12178-3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1161\/CIRCULATIONAHA.118.037655","article-title":"Sex Differences in In-Hospital Management and Outcomes of Patients with Acute Coronary Syndrome: Findings from the CCC Project","volume":"139","author":"Hao","year":"2019","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.hlc.2023.11.016","article-title":"Sex- and Age-Specific Differences in Risk Profiles and Early Outcomes in Adults With Acute Coronary Syndromes","volume":"33","author":"Nedkoff","year":"2024","journal-title":"Heart Lung Circ."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Rubio, H., Becerro-de-Bengoa-Vallejo, R., Rodr\u00edguez-Sanz, D., Calvo-Lobo, C., Vicente-Campos, D., and Chicharro, J.L. (2022). Exercise Training and Interventions for Coronary Artery Disease. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9050131"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1177\/2047487314545279","article-title":"Cardiac rehabilitation referral, attendance and mortality in women","volume":"22","author":"Colbert","year":"2015","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jacc.2023.12.019","article-title":"Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality","volume":"83","author":"Ji","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.jacc.2023.05.070","article-title":"Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week","volume":"82","author":"Petek","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/s41569-023-00873-3","article-title":"The contribution of the exposome to the burden of cardiovascular disease","volume":"20","author":"Hahad","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2880","DOI":"10.1093\/cvr\/cvab316","article-title":"Environmental risk factors and cardiovascular diseases: A comprehensive expert review","volume":"118","author":"Hahad","year":"2022","journal-title":"Cardiovasc. Res."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/2\/102\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T05:14:13Z","timestamp":1771910053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/2\/102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,21]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcdd13020102"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13020102","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,21]]}}}