292 Management of stable coronary artery disease patients: Very efficient for a population but probably insufficient for every single patient. The Indyce survey

Abstract

In studies and surveys involving stable coronary artery disease (CAD) patients, the global population often seems well managed; however, the question remains to know what is the proportion of patients who benefit from every simple medical intervention improving the prognosis or showing good quality of care. To evaluate medical management of stable CAD outpatients in France by calculating a progressive quality index. The INDYCE survey was conducted in a sample of 343 cardiologists in France in 2008. Each physician had to include consecutively 10 stable CAD patients (absence of acute coronary syndrome or revascularisation in the 6 months preceding enrolment). 3119 patients (male: 80%, 68 ± 11 years old, diabetes: 24.3%, hypertension: 61.6%) were enrolled. Medical therapy was in keeping with Guidelines (antiplatelet agents (AA) : 88.4% ; statins : 85.9% ; ACE-I/ARBs : 78.8%, beta-blockers (BB) : 74.6%). Patients suffered from mild to moderate symptoms (angina : 19.2%, NYHA class 0 or I : 43.5%, NYHA class II : 46.9%, NYHA class III : 9.3% ; NYHA class IV : 0.3%). Mean rest heart rate (HR) was of 64.2 ± 10.8 bpm, mean systolic and diastolic blood pressure (BP) of 131.8 ± 15.4 and 75.8 ± 8.4 mmHg respectively. However, when calculating a progressive quality index: (1) 44.69% of the patients received an AA + a statin + an ACE-I/ARBs + a BB (2) 29.79% had (1) and a systolic BP < 140 mmHg + a diastolic BP < 90 mmHg (3) 23.02% had (1) + (2) and a resting heart rate < 70 bpm (4) 12.6% had (1) + (2) + (3) and had a regular physical activity (5) 6.96% had (1) + (2) + (3) + (4) and had performed an exercise test during the last 12 months (6) 4.07% had (1) + (2) + (3) + (4) + (5) and were asymptomatic (no angina and NYHA class 0 or I) Stable CAD patients do not raise attention because they are often pauci-symptomatic. At a population level, they appear to be well managed. However, building a quality index allows us to show that very few of these patients benefit from every step of a simple medical management.