Jankowski Piotr, Czarnecka Danuta, Badacz Leszek, Bogacki Piotr, Dubiel Jacek S, Grodecki Janusz, Grodzicki Tomasz, Maciejewicz Janusz, Mirek-Bryniarska Ewa, Nessler Jadwiga, Piotrowski Wiesław, Podolec Piotr, Śmielak-Korombel Wanda, Tracz Wiesława, Kawecka-Jaszcz Kalina, Pająk Andrzej
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Department of Cardiology, Ludwik Rydygier District Hospital, Krakow, Poland.
Arch Med Sci. 2018 Aug;14(5):979-987. doi: 10.5114/aoms.2017.65236. Epub 2017 Jan 19.
Patients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists.
Five hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after hospitalization. The surveys were carried out in 1997-1998, 1999-2000, 2006-2007 and 2011-2013.
The proportion of smokers increased from 16.0% in 1997-1998 to 16.4% in 2011-2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% ( < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% ( = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% ( < 0.01), 47.7% and 52.8% ( = 0.53), 44.2% and 42.2% ( = 0.75) for high blood pressure, and 42.5% and 71.2% ( < 0.001), 51.4% and 79.6% ( < 0.001), 52.4% and 72.4% ( < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group.
The control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs.
已确诊冠心病（CAD）的患者发生心血管事件复发的风险很高。本分析的目的是比较初级保健医生和专科医生在实施心血管预防指南方面的时间趋势。
波兰南部五家设有心脏病科的医院参与了该研究，这些医院服务于该市及周边地区。连续入选因急性冠状动脉综合征住院或接受心肌血运重建手术的患者，并在住院后6 - 18个月进行访谈。调查分别在1997 - 1998年、1999 - 2000年、2006 - 2007年和2011 - 2013年进行。
在那些宣称由医院门诊心脏病专家决定治疗方案的患者中，吸烟者比例从1997 - 1998年的16.0%增至2011 - 2013年的16.4%；在由初级保健医生治疗的患者中，吸烟者比例从17.5%增至34.0%（P<0.01）；在私立心脏病诊所治疗的患者中，吸烟者比例从7.0%增至19.7%（P = 0.06）。高血压患者的相应比例分别为44.6%和42.4%（P<0.01）、47.7%和52.8%（P = 0.53）、44.2%和42.2%（P = 0.75）；低密度脂蛋白胆固醇水平未达推荐目标的患者比例分别为42.5%和71.2%（P<0.001）、51.4%和79.6%（P<0.001）、52.4%和72.4%（P<0.01）。在每个分析组中，开具心脏保护药物的患者比例均有所增加。
自1997/98年以来，在所有医疗环境中，CAD患者心血管风险的控制仅略有改善。在由初级保健医生提供出院后护理的患者中，发现了最大的进一步改善潜力。这与推广无烟政策和增加指南推荐药物的处方有关。
