Jankowski Piotr, Czarnecka Danuta, Wolfshaut-Wolak Renata, Łysek Radosław, Łukaszewska Anna, Bogacki Piotr, Grodecki Janusz, Mirek-Bryniarska Ewa, Nessler Jadwiga, Podolec Piotr, Kawecka-Jaszcz Kalina, Pająk Andrzej
1st Department of Cardiology and Hyper tension, Institute of Car diology, Jagiellonian University Medical College, Krakow, Poland.
Cardiol J. 2015;22(2):219-26. doi: 10.5603/CJ.a2014.0066. Epub 2014 Oct 9.
The highest priority in preventive cardiology was given to patients with established coronary artery disease (CAD). The aim of the study was to assess the implementation of guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates for patients, following their hospitalization for CAD.
Five hospitals with cardiology departments serving the city and its surround-ing districts in southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalized from January 1 2010 to April 31 2012 due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after hospitalization.
The medical records of 595 patients (mean age: 62.8 ± 9.0 years, 397 men and 198 women) were reviewed and included in the analyses. Proportions of medical records with available information on risk factors were high with the exception of total cholesterol levels as well as weight and height measurements, which were available in less than 80% of the hospital records. The prescription rate at discharge for antiplatelets was 99%, beta-blockers (BB)--85%, angiotensin converting enzyme inhibitors (ACEI) or sartans--85%, and lipid-lowering drugs--94%. Patients scheduled for coronary artery bypass grafting were significantly less often prescribed BB, ACEI or sartans, and lipid-lowering drugs. The proportion of patients with high blood pressure (≥ 140/90 mm Hg) 6-18 months after hospitalization was 47%, with high LDL cholesterol level (≥ 1.8 mmol/L) 73%, and with a high HbA1c level (≥ 7.0%) 14%, whereas 20% of participants were smokers and 80% were overweight. The proportion of patients taking an antiplatelet agent 6-18 months after hospitalization was 90%, BB--82%, ACEI--or sartan 78%, and lipid-lowering drug--82%. Overall, 33.9% of the study participants declared that they had been advised to participate in a rehabilitation/secondary prevention program following their hospitalization and 30.5% participated in a rehabilitation/secondary prevention program. However, only 28.2% took part in at least half of the planned sessions. Using a multivariate analysis we showed that, in general, risk factors control and the prescription rates of cardioprotective medications were related to the patients' age, education, and participation in a rehabilitation/secondary prevention program following their hospitalization due to CAD.
Our data provide evidence that there is a considerable potential for further reduction of cardiovascular risk in CAD patients. Our results suggest that increasing patient participation rates in rehabilitation/secondary prevention programs may improve the implementation of the secondary prevention.
在预防心脏病学中，已确诊冠状动脉疾病（CAD）的患者被列为首要关注对象。本研究旨在通过评估主要危险因素的控制情况以及CAD患者住院后心脏保护药物的处方率，来评估二级预防指南在日常临床实践中的实施情况。
波兰南部城市及其周边地区的五家设有心脏病科的医院参与了本研究。纳入年龄≤80岁、在2010年1月1日至2012年4月31日因急性冠状动脉综合征或接受心肌血运重建手术而住院的连续患者，并在住院后6 - 18个月进行访谈。
对595例患者（平均年龄：62.8±9.0岁，男性397例，女性198例）的病历进行了审查并纳入分析。除总胆固醇水平以及体重和身高测量外，有危险因素可用信息的病历比例较高，而这些信息在不到80%的医院记录中可获取。出院时抗血小板药物的处方率为99%，β受体阻滞剂（BB）为85%，血管紧张素转换酶抑制剂（ACEI）或沙坦类药物为85%，降脂药物为94%。计划进行冠状动脉搭桥手术的患者使用BB、ACEI或沙坦类药物以及降脂药物的处方率明显较低。住院后6 - 18个月，高血压（≥140/90 mmHg）患者的比例为47%，低密度脂蛋白胆固醇水平高（≥1.8 mmol/L）的患者比例为73%，糖化血红蛋白水平高（≥7.0%）的患者比例为14%，而20%的参与者为吸烟者，80%超重。住院后6 - 18个月服用抗血小板药物的患者比例为90%，服用BB的为82%，服用ACEI或沙坦类药物的为78%，服用降脂药物的为82%。总体而言，33.9%的研究参与者表示他们在住院后曾被建议参加康复/二级预防计划，30.5%的人参加了康复/二级预防计划。然而，只有28.2%的人参加了至少一半的计划课程。通过多变量分析我们发现，一般来说，危险因素的控制以及心脏保护药物的处方率与患者的年龄、教育程度以及因CAD住院后参加康复/二级预防计划有关。
我们的数据表明，CAD患者心血管风险仍有进一步降低的巨大潜力。我们的结果表明，提高患者在康复/二级预防计划中的参与率可能会改善二级预防的实施情况。
