Document Detail


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.
MedLine Citation:
PMID:  20054766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 Krak?w and surrounding districts (former Krak?w 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 Krak?w 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.
Authors:
Andrzej Pajak; Piotr Jankowski; Kalina Kawecka-Jaszcz; S?awomir Surowiec; Renata Wolfshaut; Magdalena Loster; Katarzyna Batko; Leszek Badacz; Jacek S Dubiel; Janusz Grodecki; Tomasz Grodzicki; Janusz Maciejewicz; Ewa Mirek-Bryniarska; Wies?aw Piotrowski; Wanda Smielak-Korombel; Wies?awa Tracz
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Kardiologia polska     Volume:  67     ISSN:  0022-9032     ISO Abbreviation:  Kardiol Pol     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-01-07     Completed Date:  2010-06-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376352     Medline TA:  Kardiol Pol     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  1353-9     Citation Subset:  IM    
Affiliation:
Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiotonic Agents / therapeutic use
Comorbidity
Coronary Artery Disease / prevention & control,  therapy
Drug Utilization / statistics & numerical data
Female
Follow-Up Studies
Humans
Hypercholesterolemia / epidemiology,  prevention & control
Hyperlipidemias / epidemiology,  prevention & control
Life Style
Male
Middle Aged
Myocardial Ischemia / epidemiology,  prevention & control*,  therapy
Myocardial Revascularization / statistics & numerical data
Poland / epidemiology
Secondary Prevention / statistics & numerical data*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents

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