Prognosis role of clinical practice guidelines compliance in a chronic ischaemic heart disease primary care cohort. The BARIHD study

Abstract

Purpose: Little is known about the prognosis role of clinical practice guidelines compliance (CPGC) in chronic ischaemic heart disease (CIHD). We assessed the role of CPGC as a prognosis factor for cardiovascular (CV) mortality during the follow up of CIHD cohort in a primary care physicians (PCP) setting Methods: BARIHD was a cross-sectional multicentric study made with the collaboration of 69 PCP. The PCP included during February 2007, patients (p) that fulfil the inclusion criteria: coronary artery disease (CAD) with at least 1 year of follow up since diagnosis, diagnosis clear established (stable angina, unstable angina or myocardial infarction-MI) in a discharge summary from cardiology department. Follow-up was done by clinical review or telephone contact and death or CV events were recorded, as well as the cause of death. We consider CPGC when the patient received antiplatelets, statins and betablockers together. Results: 1108p were included, we found CPGC in only 537p (48.5%), when CPGC was present the patients were younger (69 vs. 72 years; p<0.001) and with fewer time since CAD diagnosis (5 vs. 7 years; p<0.001), higher percentage of MI cases (65% vs. 45.8; p<0.001), coronary angioplasty (83.9% vs. 66; p<0.001) or CABG (20.4% vs. 15.1; p=0.021) also during follow-up more treadmill tests and angiography were made in this group. Less percentage of hypertension, atrial fibrillation, COPD, prior heart failure was found in the CPGC group, higher presence of physical exercise, and no differences for diabetes or renal failure,. The median of follow-up was 811 days, with 13p lost. CV death was lower in CPGC group (2.2% vs. 5.8%; p=0.003). The multivariate analysis for CV death is shown in the table. Multivariate analysis for CV mortality 95% CI, 95% Confidence interval; CPGC, Clinical practice guidelines compliance. Conclusions: We found that CPGC was an important protective factor for CV mortality in a contemporary CIHD cohort from a primary care setting