BACKGROUND: Secondary prevention improves survival, yet implementation is suboptimal. We tested the impact of a systematic hospital-based educational intervention versus usual care to improve rates of adherence to secondary prevention guidelines among women hospitalized with coronary heart disease (CHD), according to their ethnic status. METHODS: Women (n = 304, 52% minorities) hospitalized with CHD were randomly assigned to a systematic secondary prevention educational intervention versus usual care. Adherence to goals for smoking cessation, weight management, physical activity, blood pressure < 140/90 mmHg, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.59 mmol/L), and use of aspirin/anticoagulants, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors were assessed at 6 months. RESULTS: On admission, minority women were less likely than white women to meet the goals for blood pressure (OR 0.46, 95% CI 0.26 to 0.80), LDL-C (OR 0.57, CI 0.33 to 0.94), and weight management (OR 0.40, 95% CI 0.20 to 0.82). There was no difference between the intervention and usual care groups in a summary score of goals met at study completion; however, minority women in the intervention group were 2.4 times more likely (95% CI 1.13 to 5.03) to reach the blood pressure goal at 6 months compared with minority women in usual care. White women in the intervention group were 2.86 times more likely (95% CI 1.06 to 7.68) to report use of beta-blockers at 6 months compared with white women in usual care. In a logistic regression model, the interaction term for ethnic status and group assignment was significant for achieving the blood pressure goal (p = 0.009). CONCLUSIONS: A healthcare systems approach to educate women about secondary prevention and blood pressure control may differentially benefit ethnic minority women compared with white women.

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