Secondary prevention of coronary artery disease in hospital practice over the decade 1996-2006. Results of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease and Polish parts of the EUROASPIRE II and EUROASPIRE III surveys.

BACKGROUND: Both in the European and Polish guidelines the highest priority for preventive cardiology was given to patients with established cardiovascular disease. The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was initiated in 1996. The main goal of the program was to assess and improve the quality of clinical care in the secondary prevention of ischaemic heart disease. Later, the same centres joined the EUROASPIRE (European Action on Secondary and Primary Prevention Intervention to Reduce Events) II and III surveys. AIM: To compare the quality of secondary prevention in Krakow cardiac departments in 1996/1997, 1998/1999 and 2005/2006. METHODS: Five hospitals serving the area of the city of Krakow and surrounding districts (former Krakow Voivodship), inhabited by 1,200,000 persons, took part in the surveys. Consecutive patients hospitalised from July 1, 1996 to September 31, 1997 (first survey), from March 1, 1998 to March 30, 1999 (second survey), and from April 1, 2005 to July 31, 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of <71 years were recruited and included to the present analysis. All medical records were reviewed by trained reviewers using standardised data collection forms. RESULTS: Medical records of 536 patients treated in 1996/1997, 515 treated 1998/1999, and 540 treated in 2005/2006 were reviewed and analysed. Proportions of medical records with available information on risk factors prior to hospitalisation as well as proportions of medical records with available information on blood pressure (by 10%, p < 0.05) and lipids (by over 30%, p < 0.05) measurements during the first 24 h of hospitalisation as well as on weight and height measurements (by 16%, p < 0.05) increased significantly from 1996/1997 to 2005/2006. Antiplatelets prescription rate at discharge increased from 87% to 97% (p < 0.05), prescription rate for beta-blockers increased from 66% to 91% (p < 0.05), ACE inhibitors/sartans from 50% to 89% (p < 0.05), and lipid lowering drugs from 27% to 96% (p < 0.05) between 1996/1997 and 2005/2006, respectively. CONCLUSIONS: The implementation of secondary prevention guidelines into clinical practice in the Krakow cardiac departments improved in 2005/2006 as compared to 1996/1997 and 1998/1999. Our results suggest that recent decade brought significant improvement in the approach to secondary prevention of ischaemic heart disease in hospital practice.

Changes in secondary prevention of coronary artery disease in the post-discharge period over the decade 1997-2007. Results of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease and Polish parts of the EUROASPIRE II and III surveys.

BACKGROUND: Both in the European and Polish guidelines, the highest priority for preventive cardiology was given to patients with established coronary artery disease (CAD). The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was introduced in 1996 to assess and improve the quality of clinical care in secondary prevention. Departments of cardiology of five participating hospitals serving the area of the city of Kraków and surrounding districts (former Kraków Voivodship) inhabited by a population of 1 200 000 took part in the surveys. In 1999/2000 and 2006/2007 the same hospitals joined the EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) II and III surveys. The goal of the EUROASPIRE surveys was to assess to what extent the recommendations of the Joint Task Force of International Scientific Societies were implemented into clinical practice. AIM: To compare the quality of secondary prevention in the post-discharge period in Kraków in 1997/1998, 1999/2000 and 2006/2007. METHODS: Consecutive patients hospitalised from 1 July 1996 to 31 September 1997 (first survey), from 1 March 1998 to 30 March 1999 (second survey), and from 1 April 2005 to 31 July 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of 71 years were identified and then followed up, interviewed and examined 6-18 months after discharge. RESULTS: The number of patients who participated in the follow-up examinations was 418 (78.0%) in the first survey, 427 (82.9%) in the second and 427 (79.1%) in the third survey. The use of cardioprotective medication increased significantly: antiplatelets from 76.1% (1997/1998) to 86.9% (1999/2000) and 90.1% (2006/2007), beta-blockers from 59.1% (1997/1998) to 63.9% (1999/2000) and 87.5% (2006/2007), and ACE inhibitors/sartans from 45.9% (1997/1998) to 79.0% (2006/2007). The proportion of patients taking lipid lowering agents increased from 34.0% (1997/1998) to 41.9% (1999/2000) and 86.8% (2006/2007). Simultaneously, a significant improvement in the control of hyperlipidemia could be noted. In 2006/07, over 60% had a serum LDL cholesterol < 2.5 mmol/l. No significant change was found in the proportion of subjects with well-controlled hypertension or diabetes. In 2006/2007, elevated blood pressure was found in 46.6% of participants and glucose > 7 mmol/l in 13.4%. There was no significant change in smoking rates (16.3 vs. 15.9 vs. 19.2%). The proportion of obese patients increased reaching 33.9% in 2006/2007. CONCLUSIONS: The implementation of CAD prevention guidelines into clinical practice over the decade from 1997/1998 to 2006/2007 changed significantly. The use of cardioprotective drugs increased largely but among risk factors a significant improvement could be found only in the case of hypercholesterolemia. No improvement in the control of hypertension and diabetes, no change in smoking rates and increasing prevalence of obesity suggest insufficient lifestyle modifications in CAD patients.

[Secondary prevention of ischemic heart disease in diabetics in clinical practice]. / Realizacja zalecen dotyczacych wtórnej prewencji choroby niedokrwiennej serca u osób z cukrzyca w codziennej praktyce.

BACKGROUND: Diabetes is an indication for particularly careful risk factors management in ischaemic heart disease patients. AIM: The aim of the study was to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in diabetics. METHODS: We reviewed hospital records of 1051 consecutive patients at age < or = 70 years with discharge diagnosis of acute myocardial infarction, unstable angina, percutaneous coronary intervention or coronary artery bypass surgery who were hospitalized in three university and in three community cardiac departments serving the area of the city. The follow-up interview took place 6-18 months after discharge. RESULTS: Out of 1051 (754 men and 297 women; mean age 57.1 +/- 8.4 years) study participants 160 (15.2%) were diagnosed as having diabetes. ACE inhibitors were prescribed at discharge more often (73.1% vs 47.6%; p < 0.0001) whereas beta-blockers (54.4% vs 66,0%; p < 0.01) and lipid-lowering drugs (25.0% vs 35.9%; p < 0.01) less often in diabetics compared to non-diabetics. One year after discharge diabetics smoked less frequently compared to non-diabetics (9.8% vs 17.2%; p < 0.05). No significant difference was found in the prevalence of high blood pressure, high total and LDL cholesterol levels, low HDL cholesterol level and high triglycerides level in diabetic and non-diabetic patients. The prevalence of obesity increased after hospitalization in both groups. ACE inhibitors were used more often (61.5% vs 44.3%; p < 0.001) whereas lipid-lowering drugs less often (27.1% vs 39.8%; p < 0.01) in diabetics compared to non-diabetics. Diabetes was not independently related to the frequency of lipid-lowering drug use in patients with hypercholesterolemia. CONCLUSIONS: Insufficient control of risk factors and too low prescription rate of secondary prevention drugs were found both in diabetic and non-diabetic patients. There is a need to intensify secondary prevention, especially in patients with diabetes.