Abstract P343: Patients With Cardiovascular Disease Are Not Meeting American Heart Association Secondary Prevention Recommendations

Abstract

Introduction: In the United States, cardiovascular disease (CVD) is the leading cause of mortality. More than 92 million Americans have one or more types of CVD and 800,000 die from it annually. More than 47% of myocardial infarction survivors and 30% of stroke survivors get recurrent events, and therefore there is need for data on secondary preventive care, if the AHA’s 2020 impact goal is to be achieved. We assessed the hypothesis that patients with CVD were not meeting AHA secondary preventive guidelines, and there was gender and racial disparities in care. Methods: This study is an analysis of the 2017 Behavioral Risk Factor Surveillance System a chronic disease survey conducted by the CDC. The sample included 51,626 subjects with a history of stroke and coronary artery disease. The secondary preventive measures analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure medications in hypertensive patients and the use of aspirin. Gender and racial disparities were analyzed using multiple logistic regression analysis and age, race, education and income were adjusted for in the outcomes. Results: The median age of the study cohort was 69 years (variance=140). White, black and Hispanic patients represented 79.3%, 8.6% and 6.7% respectively. Females comprised 48.5%. Comorbidities included: hypertension (72.8%), dyslipidemia (63.5%), diabetes mellitus (31.5%) and chronic kidney disease (11.5%). Among CVD patients, 57.1% reported ever smoking and 17.4% of them still smoked. Only 39.2% met AHA aerobic exercise guidelines and 12.1% met both the aerobic and muscle strengthening exercise guidelines. Thirty nine percent of CVD patients undertook more than 150 minutes of aerobic exercise and 12% did 1-149 minutes per week. Obesity/overweight was present in 73.8%. Only 67.8% of patients with CVD were using aspirin, 20% were not on any cholesterol medication (not specified whether statin) while among hypertensive patients, 90.1% were on antihypertensive medications. There were major racial and gender disparities in smoking status [women vs men adjusted OR (aOR) 1.23 (1.21 - 1.25), Hispanic vs white aOR 1.71 (1.66 - 1.76)], aspirin [women vs men aOR 0.66 (0.62 - 0.71), Hispanic vs white aOR 0.56(0.47 - 0.58)]. Women were more likely to be on BP medications [women vs men aOR 1.25 (1.22 - 1.29)]. Conclusion: Patients with stroke do not meet AHA lifestyle and aspirin recommendations. There are major gender and racial disparities in the use of CVD secondary preventive measures.