Magnani Bruno, Dal Palù Cesare, Zanchetti Alberto
Institute of Cardiology, University of Bologna, Bologna, Italy.
Ital Heart J. 2002 Feb;3(2):86-95.
The aims of MC'95 were to verify i) whether the main risk factors for coronary heart disease had been recorded in the hospital medical records of patients admitted for coronary events; ii) how modifiable risk factors had been managed by drug therapy and lifestyle advices following hospitalization; iii) whether first-degree blood relatives of patients had been screened for coronary heart disease risk factors.
The survey concerned 40 hospital units across Italy admitting patients with acute coronary events or offering interventional cardiology or cardiac surgery. Two thousand and four hospital records (50 for each unit) of consecutive patients (< or = 74 years, 21% women) discharged within 6 months before initiation of the study (November 1995) were reviewed and the patients were invited for a follow-up examination from 6 to 9 months after hospital discharge.
The prevalence of patients positive for risk factors reported was: 58.5% for high total cholesterol (> or = 5.2 mmol/l), 46.9% for high blood pressure (> or = 140/90 mmHg), 35.2% for smoking, 20.2% for high blood glucose (> 7 mmol/l), and 14.2% for obesity (body mass index > or = 30 kg/m2). A number of medical records did not provide complete information on risk factors: 24.1% for body mass index, 11.0% for serum cholesterol, and 11.6% for a family history of premature coronary heart disease. Eighty-nine percent of the patients attended the follow-up examination. Their care during the follow-up period was managed by general practitioners (30.5%), cardiologists (37.2%) and/or at hospital outpatient clinics (42.4%). At follow-up examination the prevalence of hypercholesterolemia increased to 62.2%, that of uncontrolled hypertension decreased to 32.2%, and the percentage of smokers decreased to 13.6%. The adherence to the drug treatment prescribed at discharge was as follows: 69.6% for lipid-lowering agents, 81.2% for ACE-inhibitors and beta-blockers, and 90.8% for antiplatelet agents. A family history of premature heart disease was reported in 55.1% of patients but screening for coronary heart disease risk factors was extended to relatives in less than 25% of cases.
The prevalence of modifiable risk factors is high in patients with different clinical manifestations of coronary heart disease. The prescriptions for secondary prevention and their efficacy after hospital discharge and the surveying of relatives for primary prevention need to be improved. For this purpose, a more coordinated intervention of primary care physicians, cardiologists and cardiac surgeons is mandatory.
MC'95的目的是验证：i）冠心病的主要危险因素是否已记录在因冠心病事件入院患者的医院病历中；ii）住院后可改变的危险因素通过药物治疗和生活方式建议是如何管理的；iii）患者的一级血亲是否接受了冠心病危险因素筛查。
该调查涉及意大利40个医院科室，这些科室收治急性冠脉事件患者或提供介入心脏病学或心脏外科手术。回顾了在研究开始前6个月内（1995年11月）出院的2004份连续患者（年龄≤74岁，21%为女性）的医院病历，并邀请患者在出院后6至9个月进行随访检查。
报告的危险因素阳性患者患病率如下：总胆固醇高（≥5.2 mmol/L）为58.5%，高血压（≥140/90 mmHg）为46.9%，吸烟为35.2%，高血糖（>7 mmol/L）为20.2%，肥胖（体重指数≥30 kg/m²）为14.2%。一些病历未提供关于危险因素的完整信息：体重指数方面为24.1%，血清胆固醇方面为11.0%，早发冠心病家族史方面为11.6%。89%的患者参加了随访检查。随访期间他们的护理由全科医生（30.5%）、心脏病专家（37.2%）和/或医院门诊（42.4%）管理。在随访检查时，高胆固醇血症患病率增至62.2%，未控制的高血压患病率降至32.2%，吸烟者百分比降至13.6%。出院时所开药物治疗的依从性如下：降脂药为69.6%，血管紧张素转换酶抑制剂和β受体阻滞剂为81.2%，抗血小板药为90.8%。55.1%的患者报告有早发心脏病家族史，但不到25%的病例将冠心病危险因素筛查扩展至亲属。
在冠心病不同临床表现的患者中，可改变危险因素的患病率很高。二级预防的处方及其出院后的疗效以及对亲属进行一级预防的筛查需要改进。为此，初级保健医生、心脏病专家和心脏外科医生进行更协调的干预是必不可少的。
