Clinical characteristics and methods of treatment of patients with stable coronary heart disease in the primary care settings - the results of the Polish, multicentre Angina Treatment Pattern (ATP) study

Abstract

For further improvement of coronary heart disease (CHD) management large epidemiological studies are required to characterise the real population of patients with CHD, treated in the primary care settings, and to evaluate how the guidelines are implemented in the everyday clinical practice. The aim of the Angina Treatment Pattern (ATP) survey was to characterise (i) the population of patients, treated by the primary care physicians for stable CHD, (ii) the methods applied by the primary care physicians to establish diagnosis of CHD and (iii) the pharmacological therapies for CHD. Across Poland, 397 primary care physicians were randomly selected. They recruited 7420 patients (49% men; mean age, 62 +/- 10 years; range: 25-93 years), treated for stable CHD. The duration of CHD was 7.4 +/- 6.6 years (range: 6 months-50 years), 2750 (37%) patients had myocardial infarction. The following risk factors of CHD were present: arterial hypertension in 58%, dyslipidaemia in 52%, smoking in 40%, family history of CHD in 56% and obesity or overweight in 73% of patients. Primary care physicians based a diagnosis of CHD predominantly on a history of anginal pain (in 33% patients), accompanied either by abnormal resting ECG or positive exercise test (in additional 31% patients). Only in 5% of patients, coronary angiography was applied to diagnose CAD. The following groups of drugs have been used: long-acting nitrates in 90%, anti-platelet drugs or anti-coagulants in 71% (aspirin in 65%), angiotensin-converting enzyme inhibitors in 51%, beta-blockers in 48%, calcium antagonists 31%, hypolipaemic drugs in 23% (statins in 10%) and metabolic agents in 16% of patients. Despite an extensive use of classical anti-anginal drugs (including at least one of the following: long-acting nitrates, beta-blockers, calcium antagonists in 95% of patients), 85% of patients still complained of anginal symptoms. Neither prevalence of angina among patients nor nitroglycerin intake depended on the number of anti-anginal drugs taken (monotherapy vs. combination therapy: 82% vs. 86% and 4.9 vs. 5.3 doses weekly, respectively). Among the primary care physicians, the methods used to establish a CHD diagnosis and the mode of CHD management are far from optimal. The results of the ATP study confirm the need for further intensification of activities to improve the process of diagnosis and management among patients with CHD, treated by the family doctors.