Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
North Karelia Hospital District, 80210 Joensuu, Finland.
Int J Environ Res Public Health. 2018 Apr 11;15(4):724. doi: 10.3390/ijerph15040724.
Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients ( = 2556) during 2011-2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients' sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.
尽管有全面的国家治疗指南，但芬兰各地在冠心病（CHD）二级预防目标方面仍未得到充分实现。我们调查了北卡累利阿医院区（CHD 心血管负担非常高）记录的 CHD 风险因素率及其空间差异，以便对高风险地区二级预防的状况形成总体看法。使用适当的 CHD 诊断疾病代码和经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的编码，从电子病历中确定符合二级预防条件的患者群体。2011-2014 年期间新患者（=2556）的累积发病率在各城市之间从 1.9%到 3.5%不等。根据国家指南定义的治疗目标评估 CHD 二级预防的成功情况。健康中心由城市管理，主要报告单位是城市，同时按年龄、性别和居住地点对患者进行综合分类。发现并解释了城市之间、定居类型和患者群体之间的健康差异。此外，还检测到急性 CHD 的空间高危和低危集群。达到低密度脂蛋白胆固醇（LDL-C）治疗目标的患者比例在各城市之间从 21%到 38%不等。患者随访方面也存在差异；例如，各城市 LDL-C 随访测量率从 72%到 86%不等。患者社会人口统计学和邻里特征以及发病负担的空间变化部分解释了结果的差异，但城市之间的护理过程也可能存在差异，这需要进行独立研究。
