Evaluation of the Effectiveness of an Interdisciplinary Intervention After Acute Coronary Syndrome on Low-Density Lipoprotein Cholesterol Levels

• "New" care pathway (Behavioral), also known as Interdisciplinaire consultation, Identifying personalized goals, Educational/preventive care, Advanced practice nurse, Dietitian, Pharmacist, Acute coronary syndrome, Follow-up consultations with an advanced practice nurse, Coaching, Adjustement of therapies, Coordination of the care pathway: Initially, the patient will have an interdisciplinary consultation aimed at identifying personalized goals for the patient and providing educational/preventive care using tools that will be provided to all centers. This consultation will bring together a cardiologist, an advanced practice nurse (APN), a dietitian and a pharmacist. This consultation will take place approximately 4 weeks after the hospitalization for acute coronary syndrome (ACS). Secondly, the patient will have 3 follow-up consultations with the APN (at 3, 6 and 12 months after discharge from hospitalization for an ACS). During these consultations, the APN will perform a clinical assessment, a personalized educational support, a coaching based on the patient's personalized goals, an adjustment of therapies and, depending on needs, referral to other health professionals.
• "Standard" care pathway (Other): The French National Health Authority recommends two medical visits (at 6 and 12 month) and, if necessary, a third one (between the first and third month post-ACS) for the monitoring of the left ventricular. - The European Society of Cardiology recommends a reassessment of the lipid profile within 4-6 weeks post-ACS.

Primary outcomes

• Proportion of patients reaching the LDL cholesterol target [At enrollment then at the 12th month]: The target is definde as LDL cholesterol level <0.55 g/L and >50% reduction from baseline

Secondary outcomes

• Proportion of patients reaching the LDL cholesterol target [At enrollment then at the first month, 6th month and 12th month]: The target for this outcome is defined as LDL cholesterol <0.55 g/L
• Proportion of patients reaching the LDL cholesterol target [At enrollment then at the first month, 6th month and 12th month]: The target for this outcome is defined as LDL cholesterol level reduction > 50% compared to baseline value
• Changes in cardiovascular risk factors [At enrollment then at the first month, 6th month and 12th month]: This outcome aims to assess changes in the patient's overall cardiovascular risk profile throughout the study. Multiple parameters will be evaluated to capture a comprehensive picture of the modifications in cardiovascular risk factors presented by each patient. The parametrers will be: * Dyslipidemia: Proportion of patients achieving the LDL cholesterol target set by the European Society of Cardiology (<0.55 g/L and >50% reduction from baseline) * Hypertension: Proportion of patients achieving a systolic blood pressure < 140 mmHg and a diastolic blood pressure < 90 mmHg * Percentage of patients with controlled type 2 diabetes (for a diabetic patient, HbA1c target <7%) * BMI
• Physical Activity Score [At enrollment then at the 6th month and 12th month]: Total score on the "Ricci and Gagnon Self-Assessment of Physical Activity" Questionnaire (activity self-assessment questionnaire). The minimum value is 9 The maximum value is 45 Under 18: inactive Between 18 and 35: active Over 35: very active
• Proportion of patients who participated in a cardiac rehabilitation program [At 6th month and 12th month]: This outcome aims to assess the proportion of patients who engage in a cardiac rehabilitation program following an acute coronary syndrome
• Proportion of patients consuming toxic substances and their quantity measured [At enrollment then at the 6th month and 12th month]: The substances involved are: alcohol, tobacco, and drugs
• Quality of life score [At enrollment then at the 6th month and 12th month]: Measured using the EQ-5D-5L Questionnaire (European quality of life 5 dimensions 5 levels questionnaire) The (EQ-5D-5L) questionnaire provides two types of scores. The first is an index scored derived from five health dimensions (mobility, self-care, actual activities, pain/discomfort, and anxiety/depression) converted into a single value ranged from 0 (representing health states considered worse than death) to 1(representing perfect health). The second is the EQ Visual Analogue Scale (EQ-VAS), a self-rated health measure ranging from 0 ("the worst health you can imagine") to 100 ("the best health you can imagine") representing self-rated health.
• Therapeutic Compliance Score [At enrollment then at the 6th month and 12th month]: Measured using FREEDOM questionnaire (FREE Detection non Observance Medication) The FREEDOM questionnaire includes 11 items rated on a 4-point Likert scale ranging from "strongly disagree" to "strongly agree". The questionnaire responses will be used qualitatively, without calculation of a numerical total score, to classify patients into categories of medication adherence (low, moderate, high).
• List of lipid-lowering treatments taken by patients [At enrollment then at the first month, 6th month and 12th month]: This outcome aims to describe the lipid-lowering therapy prescribed to each patient, as well as any modifications made during follow-up. This outcome focuses solely on documenting which lipid-lowering treatments patients are receiving and does not involve any comparison or evaluation of the effectiveness or safety of different lipid-lowering therapie
• Number of medical (cardiologist or general practitioner) and/or paramedical (dietician, etc.) consultations [At 6th month and 12th month]
• Mortality rate and the reasons [At 6th month and 12th month]
• Rehospitalization rates and the reasons [At 6th month and 12th month]
• Rate of cardiovascular events [At 12th month]
• Estimation of cost per QALY gained and cost per serious cardiac event avoided [At 12th month]: QALY: quality-adjusted life year
• Professional satisfaction rate by using a satisfaction scale from 0 to 10 [At 12th month]: Satisfaction with the care provided to the patient under the EDUSCA protocol

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adult patients hospitalized for ACS (ST+ or ST-), affiliated with a social security scheme, able to understand the protocol and having signed the study consent.

Exclusion Criteria:

* Patients with a complication of the ACS (mechanical complication, cardiogenic shock, very severe left ventricular dysfunction, presence of an intraventricular thrombus, complex ventricular rhythm disorder) ;
* Proven cognitive impairment or decompensated psychological/psychiatric disorder ;
* Any progressive inflammatory and/or infectious condition ;
* Any orthopedic problem precluding the physical activity ;
* Current participation in any clinical research project aimed at reducing LDL cholesterol levels ;
* Pregnant or breastfeeding woman ;
* Patient receiving state medical assistance ;
* Patient under guardianship or curatorship, or any other legal protection measure ;

• Melissa JOLY GOURJAULT, Principal investigator, Hôpital Européen Georges Pompidou - AP-HP
• Thibaut CARUBA, Study chair, Hôpital européen Georges-Pompidou - AP-HP