Secondary Prevention Of Coronary Heart Disease Research Articles

A global perspective on cardiovascular risk factor management in patients with CHD and different educational level: SURF CHD II

Abstract Background Clinical guidelines recommend that patients with established coronary heart disease (CHD) change health behaviors and use medication to control risk factors (RF), eventually reducing cardiovascular risk. Nevertheless, RF management in daily practice is challenging and RF control in secondary prevention remains suboptimal. Patients with low educational level tend to have higher cardiovascular risk. This association varies indifferent contexts, yet research on health inequalities in secondary prevention has focused mostly on high-income countries. Purpose To provide a global picture of health inequalities in RF management in secondary prevention of CHD, by assessing RF recording, target attainment, and treatment by educational level in patients from four world regions. Methods The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II is a clinical audit on RF management, undertaken in patients with CHD during routine outpatient visits. The survey is easy to perform, allowing its use in low-resource centers. We studied RF recording (data availability), attainment of targets defined by guidelines, and treatment (medication and cardiac rehabilitation). RF included smoking, physical activity, waist circumference, blood pressure, LDL, non-HDL cholesterol, triglycerides, and Hba1c (among diabetics). We reported the % of recording, target attainment and treatment in patients with primary/secondary schooling and in those with tertiary education. We assessed differences in RF management by educational level with logistic regression adjusted by age and sex, and stratified by region. Results 13884 patients were enrolled in 29 countries in Europe (N=10255), South-East Asia (SEA) (N=2290), the Americas (N=779) and North Africa and Eastern Mediterranean (N=560). 47.0% of participants had tertiary education, 34.5% had secondary schooling, and 18.6% primary schooling. RF recording ranged from 22.2% (waist circumference) to 93.0% (blood pressure); target attainment from 15.9% (waist circumference) to 76.9% (smoking). 50.5% participated in cardiac rehabilitation. RF information was collected more often in highly educated patients for most RF in the Americas, and for blood pressure and HBa1c in SEA. BMI and waist circumference were more frequently registered among lower-educated participants in Europe and SEA. Highly educated patients were more likely to meet RF targets for smoking in most regions, physical activity in Americas and Europe, LDL in SEA, and Non-HDL cholesterol and Hba1c in SEA and Americas regions. Patients with higher education participated more often in cardiac rehabilitation in all regions except SEA (Figure 1). Conclusions Health inequalities persist in secondary prevention of CHD: highly educated patients are generally more likely to have RF information recorded, have RF levels on target and attend cardiac rehabilitation. However, these associations present specific patterns by RF and region.

Initial Implementation of the My Heart, My Life Program by the National Heart Foundation of Australia: Pilot Mixed Methods Evaluation Study.

Coronary heart disease (CHD) remains the leading cause of death in Australia, with a high residual risk of repeat events in survivors. Secondary prevention therapy is crucial for reducing the risk of both death and other major adverse cardiac events. The National Heart Foundation of Australia has developed a consumer-facing support program called My Heart, My Life (MHML) to address the gap in the secondary prevention of CHD in Australia. The MHML pilot program supplies advice and support for both patients and their caregivers, and it was conducted over 8 months from November 2019 to June 2020. This study aims to describe and examine the implementation of a novel multimodality secondary CHD prevention pilot program called MHML, which was delivered through booklets, text messages, emails, and telephone calls. This pilot study consists of a mixed methods evaluation involving surveys of participants (patients and caregivers) and health professionals, in-depth interviews, and digital communication (SMS text message, electronic direct mail, and call record analytics). This study was performed in people older than 18 years with acute coronary syndrome or angina and their caregivers in 38 Australian hospitals from November 2019 to June 2020 through the National Heart Foundation of Australia web page. The main outcome measures were reach, accessibility, feasibility, barriers, and enablers to implementation of this program. Of the 1004 participants (838 patients and 164 caregivers; 2 missing), 60.9% (608/1001) were males, 50.7% (491/967) were aged between 45 and 64 years, 27.4% (276/1004) were from disadvantaged areas, 2.5% (24/946) were from Aboriginal or Torres Strait Islander background, and 16.9% (170/1004) reported English as their second language. The participants (patients and their caregivers) and health professionals reported high satisfaction with the MHML program (55/62, 88.7% and 33/38, 87%, respectively). Of the 62 participants who took the survey, 88% (55/62) used the text messaging service and reported a very high level of satisfaction. Approximately 94% (58/62) and 89% (55/62) of the participants were satisfied with the quick guide booklets 1 and 2, respectively; 79% (49/62) were satisfied with the monthly email journey and 71% (44/62) were satisfied with the helpline calls. Most participants reported that the MHML program improved preventive behaviors, that is, 73% (45/62) of them reported that they maintained increased physical activity and 84% (52/62) reported that they maintained a healthy diet even after the MHML program. The findings of our pilot study suggest that a multimodal support program, including digital, print, phone, and web-based media, for the secondary prevention of CHD is useful and could be a potential means of providing customized at-scale secondary prevention support for survivors of acute coronary syndrome.

Secondary prevention of Coronary Heart Disease (CHD) in the Moroccan population. Survey of Risk Factor (SURF) CHD II Morocco

Abstract Funding Acknowledgements Type of funding sources: None. Background Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk. SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD). The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology. Methods Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded. Results A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years. Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels. Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure <140/90mmHg and 27.3% had LDL <1.8mmol/L. Cardiac rehabilitation programs were attended by 3.5 % of participants. The level of target attainment in Morocco was like regional and global levels for smoking; like regional but lower than global results for physical activity; and lower than regional and global estimates for blood pressure and LDL. Conclusion The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.

Arterial hypertension management in patients with confirmed coronary heart disease: how far are we from meeting prevention goals?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction International registry studies offer useful information on the state of the cardiovascular risk factor management. The SURF CHD (Survey of Risk Factors in Coronary Heart Disease) II study is a clinical audit of the recording and management of major cardiovascular (CV) risk factors in patients with established coronary heart disease (CHD). CV risk factors’ control varies by countries and is typically insufficient, according to the prior studies. Purpose This study aimed to assess adherence to European Society of Cardiology (ESC) recommendations for secondary prevention of cardiovascular diseases based on the measurement of blood pressure (BP) control and its therapeutic management in patients with confirmed CHD at different hospitals in one of the regions at high risk for cardiovascular disease. Methods Eight public and private health care centres of Azerbaijan participated in the SURF CHD II study between November 2019 and April 2022. A one-page standard questionnaire of the study was used to collect information electronically on demographics, diagnostic category, risk factors, physical and laboratory data, and prescribed medications from consecutive patients aged ≥18 years with established CHD during outpatient visits. Uncontrolled arterial hypertension (AH) is identified as follows: systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. Results Data from 949 patients with CHD (the mean age 59.6±9.58 years; 27.3% female) were included in the study. Only 11.7% of participants were involved in a cardiac rehabilitation program. Previous history of AH was registered in 73,1% of participants, while uncontrolled SBP was detected in 59.6% of them. Regarding medications, 82.4% of patients were taking antihypertensive drugs: 52.2% were taking beta-blockers, 51.2% ACE inhibitors, 7.9% ARBs, and 31.7% calcium antagonists. Only 11.7% of participants were involved in a cardiac rehabilitation program. Conclusion The study results have shown that the implementation of the current ESC recommendations for CHD secondary prevention and in particular the control rate of BP is insufficient. Given the fact that patients are at very high risk with different comorbid pathologies, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at high risk for cardiovascular disease.

Less risk factor at AMI onset, higher risk in prognosis---the paradoxical phenomenon from MIMIC-III database

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China (NSFC). Introduction Numerous epidemiologic studies have confirmed that Standard Modifiable Cardiovascular Risk Factors (SMuRFs) are independent risk factors for coronary heart disease (CHD) and are recommended by guidelines for the primary and secondary prevention of CHD. However, it is interesting to find that the increasing proportion of individuals without SMuRFs in CHD and acute myocardial infarction (AMI). Moreover, accumulating clinical trials have reported the inverse association between the number of risk factors and crude mortality in AMI. It is unknown whether this paradoxical phenomenon can be seen in critical ill patients. Purpose To analyze and validate whether the number of risk factors contradicts the mortality outcome in patients with AMI in the MIMIC-III (Medical Information Mart for Intensive Care III) database. Methods A total of 2484 AMI patients (62.8% male, mean age 71.2 [59.3;80.8] years) admitting to cardiac care unit for the first time from the MIMIC-III database were enrolled. Risk factors were defined as hypertension, diabetes,dyslipidemia, and smoking history. They were grouped according to the number of risk factors. Main outcome was mortality at 2-year following hospitalization. Kaplan-Meier curve and Cox proportional hazards models adjusting for baseline clinical characteristics and in-hospital treatment were constructed to evaluate the impact of numbers of risk factors on mortality in critical AMI patients. Results At 2-year follow-up, death was observed in 714 patients (28.7%). A total of 474(19.1%),1541(62%),469(18.9%) patients had 0,1-2,3-4 SMuRFs respectively. No risk group has a significantly higher 2-year mortality (Picture 1). Compared with no risk group, patients with 1-2 and 3-4 SMuRFs were correlated to an HR of 0.72(95%CI, 0.61-0.86) and 0.66(95%CI, 0.52-0.83) for all-cause mortality in the unadjusted model. Interestingly, after multivariate adjustment, less risk factor at AMI onset was still associated with poor prognosis. Conclusions Taking into confounders, critical AMI patients with less risk factors have higher risk in poor prognosis. Further studies on this paradoxical phenomenon are needed.

Recurrence risk prediction of acute coronary syndrome per patient as a personalized ACS recurrence risk: a retrospective study.

Acute coronary syndrome (ACS) has been one of the most important issues in global public health. The high recurrence risk of patients with coronary heart disease (CHD) has led to the importance of post-discharge care and secondary prevention of CHD. Previous studies provided binary results of ACS recurrence risk; however, studies providing the recurrence risk of an individual patient are rare. In this study, we conducted a model which provides the recurrence risk probability for each patient, along with the binary result, with two datasets from the Korea Health Insurance Review and Assessment Service and Chungbuk National University Hospital. The total data of 6,535 patients who had been diagnosed with ACS were used to build a machine learning model by using logistic regression. Data including age, gender, procedure codes, procedure reason, prescription drug codes, and condition codes were used as the model predictors. The model performance showed 0.893, 0.894, 0.851, 0.869, and 0.921 for accuracy, precision, recall, F1-score, and AUC, respectively. Our model provides the ACS recurrence probability of each patient as a personalized ACS recurrence risk, which may help motivate the patient to reduce their own ACS recurrence risk. The model also shows that acute transmural myocardial infarction of an unspecified site, and other sites and acute transmural myocardial infarction of an unspecified site contributed most significantly to ACS recurrence with an odds ratio of 97.908 as a procedure reason code and with an odds ratio of 58.215 as a condition code, respectively.

High levels of risk factors and poor secondary prevention for coronary heart disease patients in public hospitals: A descriptive repeated measures study.

Secondary prevention is a priority after coronary revascularization for effective long-term cardiovascular care. Coronary Heart Disease is a major health problem in Jordan, but little is known about the current provision of secondary prevention. The aim of this study was to evaluate risk factors and explore the current provision of secondary Coronary Heart Disease prevention among patients presenting with first-time Coronary Heart Disease at two time points: during hospitalization (Time 1) and 6 months later (Time 2), in multicentre settings in Jordan. A descriptive, repeated measures research study design was applied to a consecutive sample of 180 patients with first-time Coronary Heart Disease. Demographic and clinical details were recorded from medical files. Self-administered questionnaires developed by the researchers were used to measure secondary prevention information related to Coronary Heart Disease, including secondary prevention services, lifestyle advice received and medical advice topics. A short form of the International Physical Activity Questionnaire was used to measure physical activity. Participants were assessed at Times 1 and 2. Unstructured lifestyle advice given to the patients at Times 1 and 2 most frequently related to medications, smoking, diet and blood lipids control advice topics, with no statistically significant improvement in cardiovascular risk factors among patients between Times 1 and 2. Despite an extremely high prevalence of risk factors in this population, the provision of secondary prevention is poor in Jordan, which requires urgent improvement, and the contribution of nurses' to secondary prevention should be enhanced.

Risk factor recording and management in coronary heart disease patients from 32 countries: SURF CHD II

Abstract Introduction Patients with coronary heart disease (CHD) are at high cardiovascular risk, and controlling risk factors in this population is especially important to prevent CHD morbidity and mortality. SURF CHD (Survey of Risk factors in Coronary Heart Disease) II is a clinical audit on secondary prevention of CHD. The goals are to simplify and assess the recording and management of cardiovascular risk factors in patients with CHD. Methods SURF CHD II consists in a brief online survey conducted during routine outpatient visits in patients with a previous acute coronary syndrome (ACS), stable angina, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Information is collected electronically on demographics, risk factor history (smoking history, physical activity), risk factor measurements (blood pressure, BMI, waist circumference), laboratory values and medication. Risk factor targets were defined as follows: no prior smoking or having stopped smoking, practice of at least 30 minutes of moderate physical activity 3–5 times per week, BMI <25 kg/m2, waist circumference <94 cm in men and <80 cm in women, blood pressure of <140/90 mmHg (<140/85 mmHg in diabetics), LDL <70 mg/dL, HDL >40 mg/dL in men and >45 mg/dl in women, triglycerides <150 mg/dL, and HbA1c <7% in diabetic participants. Results 12884 patients from 32 countries participated in SURF CHD in 5 regions: 10195 in Europe, 2048 in South-East Asia (SEA), 415 in the Americas, 210 in North Africa-Eastern Mediterranean (NAEM), and 13 in Western Pacific. All centres participating were located in urban areas and 81.6% were public Women represented 24.6% of the participants, mean age 64.1 years (sd 11.2 years). 57.7% of the patients had a previous PCI, 50% ACS, 29.5% stable angina and 16.1% CAGB. The percentage of risk factor recording and target attainment by region is presented in Table 1. Risk factor recording ranged from 26.8% (waist circumference) to 94.3% for blood pressure. Target attainment varied from 25.8% with a BMI <25 kg/m2, to 76.3% of participants that had never smoked or had stopped smoking. The South East Asian region presented the highest percentages of risk factor target attainment for smoking, physical activity, BMI, waist circumference and LDL. 92.% of participants used antiplatelet medication, 100% antihypertensive medication and 89.4% lipid-lowering medications. Conclusion Risk factor recording was reasonable, but poor for some risk factors such as waist circumference and Hba1c. In line with earlier clinical audits, there is still substantial room for improvement in risk factor control in this high cardiovascular risk population. There were regional variations, with the highest level of attainment for most risk factors targets in South East Asia. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): SURF II is conducted within the framework of the ESC Prevention of CVD Programme, led by the European Association of Preventive Cardiology (EAPC).

A Comprehensive Review on the Effects of Vegetarian Diets on Coronary Heart Disease.

Coronary heart disease (CHD) is one of the leading causes of morbidity and mortality worldwide. Dietary modifications in the form of a vegetarian diet can perhaps be the key to the prevention and management of cardiovascular diseases. The aims of this review are to determine the association between a vegetarian diet and CHD, to compare the risk of CHD in different types of vegetarian diets, and to assess variability in the biochemical predictors of CHD in the various vegetarian diets. Our study inferred that adherence to a plant-based diet was inversely related to the incidence of heart failure risk. Our research further supports the idea that a vegetarian diet is advantageous for the secondary prevention of CHD since it alters lipid profiles, lowers body mass index (BMI), and increases plasma antioxidant micronutrient concentrations. Additionally, eating a plant-based diet starting in adolescence is linked to a decreased risk of cerebrovascular disease (CVD) by middle age. An increase in sensitization and education efforts is imperative to ensure that people are appropriately informed about this option to significantly improve their quality of life.

Self-management in patients with coronary heart disease after stent implantation at the long-term stage: a cross-sectional study.

The self-management of risk reduction in coronary heart disease (CHD) plays an important role in mediating health outcomes following percutaneous coronary intervention (PCI), but there is a lack of research on self-management status in the long-term stage after PCI in Chinese patients with CHD. Hence, this study investigated the self-management status in the long-term stage (>2 years) after PCI in patients with CHD. The results could provide a reference for the development of targeted interventions. This cross-sectional study administered a questionnaire survey on self-management in patients with CHD who underwent PCI (convenience sampling) and had been discharged from our medical center for >2 years, excluding the patients with severe hepatic or renal dysfunction or tumor. Data about cardiovascular risk factors, including body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and self-management status, were collected. The Coronary Artery Disease Self-Management Scale (CSMS) was used to assess patient self-management. The total CSMS score was 69.5±11.0, suggesting that the patients' self-management level was average. The scores for life management, emotion management, and disease management were 87.4±9.7, 77.6±7.7, and 57.5±11.0, respectively. Significant differences were noted in the patients' self-management scores according to occupation, education level, residence, and sex (all P<0.05). The self-management ability of farmers, primary school-educated, and male participants was relatively low. Moreover, cardiovascular risk factors were positively correlated with the emotion and disease management scores. CHD patients' self-management status in the long-term stage after PCI was moderate or poor. Medical staff should provide targeted guidance and education (for example, effective guidance on smoking cessation, first aid training, repeated disease education, and use of electronic devices to improve medication compliance) to improve the self-management level for the secondary prevention of CHD.

A Quasi-Randomized Controlled Trial of an Integrated Healthcare Model for Patients with Coronary Heart Disease

Background: An increasing number of coronary heart disease (CHD) patients with an aging population are demanding available and effective out-of-hospital continuous healthcare services. However, great efforts still need to be made to promote out-of-hospital healthcare services for better CHD secondary prevention. This study aims to evaluate the effectiveness of a hospital-community-family (HCF)-based integrated healthcare model on treatment outcomes, treatment compliance, and quality of life (QoL) in CHD patients. Methods: A quasi-randomized controlled trial was conducted at the Department of Cardiology, a tertiary A-level hospital, Wuhan, China from January 2018 to January 2020 in accordance with the Consolidated Standards of Reporting Trials guidelines. CHD patients were enrolled from the hospital and quasi-randomly assigned to either HCF-based integrated healthcare model services or conventional healthcare services. The treatment outcomes and QoL were observed at the 12-month follow-up. Treatment compliance was observed at the 1-month and 12-month follow-ups. Results: A total of 364 CHD patients were quasi-randomly assigned to either integrated healthcare model services (n = 190) or conventional healthcare services (n = 174). Treatment outcomes including relapse and readmission rate (22.6% vs 41.9%; relative risk [RR] = 0.54; 95% confidence interval [CI], 0.40–0.74; p = 0.0031), the occurrence of major cardiovascular events (19.5% vs 45.4%; RR = 0.43; 95% CI, 0.30–0.59; p = 0.0023), complication rate (19.5% vs 35.0%; RR = 0.56; 95% CI, 0.39–0.79; p = 0.0042), and the control rate of CHD risk factors (p &lt; 0.05, average p = 0.009) at the 12-month follow-up in the intervention group were better than those of the control group. There was no significant difference in treatment compliance at the 1-month follow-up between groups (p &gt; 0.05, average p = 0.872). Treatment compliance at the 12-month follow-up in the intervention group, including correct medication, reasonable diet, adherence to exercise, emotional control, self-monitoring, and regular re-examination, was higher than that of the control group (p &lt; 0.05, average p = 0.007). No difference was found in the compliance with smoking cessation and alcohol restriction at the 12-month follow-up between groups (p = 0.043). QoL at the 12-month follow-up in the intervention group was better than that of the control group (86.31 ± 9.39 vs 73.02 ± 10.70, p = 0.0048). Conclusions: The integrated healthcare model effectively improves treatment outcomes, long-term treatment compliance, and QoL of patients, and could be implemented as a feasible strategy for CHD secondary prevention.

The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD. Methods In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland. Results An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p&amp;lt;0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control. Conclusion Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.

Application of MAT Methodology in the Evaluation of Prescribing Adherence to Clinical Practice Guidelines for Secondary Prevention of Coronary Heart Disease in Post-Acute Coronary Syndrome Patients in Kuwait

Quantification of prescribers’ adherence to evidence-based guidelines can be used as an outcome measure to assess the impact of services on the quality of medication use. Additionally, it can help in reducing inappropriate interventions and ensure that high-quality care is provided to patients. This study aimed to evaluate prescribing practices for secondary prevention of coronary heart disease (CHD) in post-acute coronary syndromes (ST-elevation myocardial infarction [STEMI] or non-ST elevation acute coronary syndrome [NSTEACS]) patients using two medication assessment tools (MATs) at secondary and tertiary health-care settings in Kuwait. Both MATs were developed and validated based on the relevant guidelines issued by the European Society of Cardiology and the American College of Cardiology/American Heart Association. A quantitative cross-sectional multicenter study was conducted on 460 patients’ medical records collected randomly from six health-care facilities in Kuwait. Application of MATSTEMI on 232 patients’ medication records (with 85.9% applicability) resulted in intermediate overall adherence (69.8%; 95% CI: 67.6–72.0). Application of MATNSTEACS on 228 patients’ medication records (with applicability 83.2%) resulted in intermediate overall adherence (73.3%; 95% CI: 70.5–76.0). There was no significant difference between the percentages of overall adherence among patients managed post-NSTEACS compared to those managed post-STEMI (p = 0.05). Multivariable logistic regression analysis revealed that the overall adherence to the MATSTEMI criteria was significantly higher among the specialized cardiac centers than among the general hospitals (OR: 1.6; 95% CI: 1.1–2.3; p = 0.02). The overall adherence to the MATNSTEACS criteria was found to be significantly lower among non-Kuwaitis than among Kuwaitis (OR: 0.6; 95% CI: 0.5–0.9; p = 0.01) and patients with a serum LDL ≥1.8 mmol/L than those with a serum LDL-C < 1.8 mmol/L (OR: 0.5; 95% CI: 0.4–0.7; p < 0.001). The present findings revealed that both MATs were useful tools in identifying the standard of clinical performances and highlighting areas for improvement regarding secondary prevention of CHD in post-acute coronary syndrome patients.

Potential for optimizing management of obesity in the secondary prevention of coronary heart disease.

Prevention guidelines have identified the management of obese patients as an important priority to reduce the burden of incident and recurrent cardiovascular disease. Still, studies have demonstrated that over 80% of patients with coronary heart disease (CHD) fail to achieve their weight target. Here, we describe advice received and actions reported by overweight CHD patients since being discharged from hospital and how weight changes relate to their risk profile. Based on data from 10 507 CHD patients participating in the EUROASPIRE IV and V studies, we analysed weight changes from hospital admission to the time of a study visit ≥6 and <24 months later. At hospitalization, 34.9% were obese and another 46.0% were overweight. Obesity was more frequent in women and associated with more comorbidities. By the time of the study visit, 19.5% of obese patients had lost ≥5% of weight. However, in 16.4% weight had increased ≥5%. Weight gain in those overweight was associated with physical inactivity, non-adherence to dietary recommendations, smoking cessation, raised blood pressure, dyslipidaemia, dysglycaemia, and lower levels of quality of life. Less than half of obese patients was considering weight loss in the coming month. The management of obesity remains a challenge in the secondary prevention of CHD despite a beneficial effect of weight loss on risk factor prevalences and quality of life. Cardiac rehabilitation programmes should include weight loss interventions as a specific component and the incremental value of telehealth intervention as well as recently described pharmacological interventions need full consideration.

10-YEAR DYNAMIC OF FREQUENCY, USED DOSES AND ORIGINAL AND GENERIC FORMS OF MAIN DRUG GROUPS IN CORONARY HEART DISEASE REGISTRY

Abstract Objective: To assess dynamics of reception frequency, used doses and use of original and generic forms of antiplatelet drugs, statins, beta-blockers, ACE-inhibitors/ARBs in stable coronary heart disease (CHD) patients in 2004–2014 within the CHD registry. Design and method: Patients with angiographically confirmed in 2004–2007 CHD, who came for a follow-up visit in 2010 (n = 303) and in 2014 (n = 125) were included. Results: Statins were taken by 7.6% of patients prior to hospitalization and by 86.5% of patients at discharge, antiplatelet drugs by 68% and 96%, beta-blockers by 24,8% and 94%, and ACE-inhibitors by 19% and 83% of patients, respectively (p &lt; 0.001). Statins were taken by 67% and 70% of patients 4 and 7 years after discharge, respectively, antiplatelet drugs by 80% and 90%, beta-blockers by 80% and 75%, ACE-inhibitors by 66% and 65% of patients, respectively. The main 4 groups of drugs for secondary prevention of CHD were taken by 15% of patients prior to hospitalization, by 69% of patients at discharge (p &lt; 0.001), by 41% 4 years, and by 35% 7 years after discharge (p &lt; 0.01). From 2004 to 2014 all groups of drugs with an exception of antiplatelets were used in low and medium doses with an increase in the use of generic forms, especially for statins (76%). Conclusions: Frequency of assignment of beta-blockers, ACE-inhibitors/ARBs and statins in patients with stable CHD was low prior to hospitalization, increased during their hospital stay and decreased 4 and 7 years after discharge. Throughout these 10 years all drugs were used in medium and low doses, with an increase in the use of generic forms.

Self-reported medication use among coronary heart disease patients showed high validity compared with dispensing data

ObjectiveTo validate self-reported use of medications for secondary prevention of coronary heart disease (CHD) in a population-based health study by comparing self-report with pharmacy dispensing data, and explore different methods for defining medication use in prescription databases. Study design and settingSelf-reported medication use among participants with CHD (n = 1483) from the seventh wave of the Tromsø Study was linked with the Norwegian Prescription Database (NorPD). Cohen’s kappa, sensitivity, specificity, and positive and negative predictive values were calculated, using NorPD as the reference standard. Medication use in NorPD was defined in three ways; fixed-time window of 180 days, and legend-time method assuming a daily dose of one dosage unit or one defined daily dose (DDD). ResultsKappa-values for antihypertensive drugs, lipid-lowering drugs and acetylsalicylic acid all showed substantial agreement (kappa ≥0.61). Validity varied depending on the method used for defining medication use in NorPD. Applying a fixed-time window gave higher agreement, positive predictive values and specificity compared with the legend-time methods. ConclusionSelf-reported use of medication for secondary prevention of CHD shows high validity when compared with pharmacy dispensing data. For CHD medications, fixed-time window appears to be the most appropriate method for defining medication use in prescription databases.

Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Troms\xf8 7

BackgroundAdherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement.MethodWe included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015–2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol.ResultsThe prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6–54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7–2.7).ConclusionTreatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.

Efficacy and safety of colchicine for secondary prevention of coronary heart disease: a systematic review and meta-analysis.

To evaluate the efficacy and safety of colchicine for secondary prevention of coronary heart disease (CHD), relevant randomized controlled trials (RCTs) were identified by searching several databases from the creation date to August 31, 2020 and were reviewed. Eight eligible trials of colchicine therapy involving a total of 11, 463 patients were included (5, 776 subjects received colchicine, while 5, 687 subjects were in the respective control arms), and the outcome was reported as risk ratio (RR) and 95% confidence interval (CI), as the relative measure of association. Overall, the incidences of major adverse cardiovascular events (MACEs) (RR 0.70; 95% CI 0.61-0.80), myocardial infarction (MI) (RR 0.77; 95% CI 0.64-0.94), emergency readmission due to CHD (RR 0.70; 95% CI 0.58-0.86), and ischemic stroke (RR 0.49; 95% CI 0.30-0.79) were lower in the colchicine group than in the placebo arm. We did not find a significant reduction in the incidence of all-cause mortality (RR 1.03; 95% CI 0.80-1.32). Although the incidence of diarrhea in the colchicine treatment group was higher than that in the placebo arms (RR 2.53; 95% CI 1.17, 5.48), the symptoms disappeared rapidly after drug withdrawal, and no serious adverse reactions occurred. In summary, colchicine is an accessible, safe, and effective drug that could be successfully utilized for the secondary prevention of CHD. The tolerability and benefits should be confirmed in in-depth clinical trials.

Trends in in-hospital and out-of-hospital coronary heart disease mortality rates in French registers during the period 2000 to 2016

To estimate the trends in- and out-hospital coronary heart disease (CHD) mortality rates from 2000 to 2016 and their respective proportions in total mortality using data of the three French CHD registries (Strasbourg, Toulouse, Lille). All fatal myocardial infarction (MI), coronary deaths (CD) and sudden deaths occurring between January 1st, 2000 and December 31st of 2016, were recorded for patients aged 35 to 74 years. A total of 20,818 events were recorded in the three registers, of which 69.4% were out-of-hospital. Age- and region-adjusted CHD mortality rate decreased with an annual percentage change (APC) of -3.6% in men and -3.9% in women. This significant decrease was approximately twice as high for in-hospital deaths compared to out-of-hospital deaths ( P < 10 −5 for both). While the out-of-hospital death rate represented 63.6% of the standardized total CHD mortality rate in 2000 for men, it was 70.1% in 2016. For women, these parts were respectively 63.9% and 70.5%. In men aged 35 to 54, the APC was twice higher for out-of-hospital deaths (-3.0%, P < 10 −3 ) than for in-hospital deaths (-1.5%, P = 0.01) whereas the opposite was observed in men aged 55 to 74 (-1.4% P = 0.01 vs -5.2% P < 10 −5 , respectively) ( Table 1 ). More than two-thirds of the deaths from CHD occurred outside the hospital. The CHD mortality rates significantly decreased during the 2000-2016 period, for both genders. However, this decline was slighter for out-of-hospital deaths than for in-hospital deaths, pointing out the need to strengthen primary and secondary prevention of CHD.

Long-term trends in the incidence, treatment, hospital fatality and subsequent mortality from acute myocardial infarction in the Czech Republic.

Studies on the incidence, acute and subsequent mortality from myocardial infarction are limited mostly to selected clinical cohorts and populations and cover relatively short periods. Our aim was to describe and analyse long-term trends on a national scale. Acute myocardial infarction (AMI) was defined by the International Classification of Diseases (ICD)10; codes I21 and I22. Our natiowide 1994-2016 data on AMI mortality were obtained from the official mortality statistics (Czech Bureau of Statistics), data on morbidity (hospitalizations) from the National Register of Hospitalizations (Institute for Health Information and Statistics). For further analyses, data from the Czech EUROASPIRE I-V and Czech IMPACT studies were used. Over the 1994-2016 period the total number of AMI cases per year decreased from 34,084 to 19,015, that of patients hospitalized for AMI from 22,373 to 15,419, the total number of deaths due to AMI from 14,834 to 4,673, in those treated because of AMI from 3,794 to 1,137, and hospital fatality in patients treated for AMI decreased from 17% to 7.5%. Over the years 1997-2016, the one-year all-cause mortality rate after AMI declined from 25.1 to 17.9%, cardiovascular (CV) mortality from 22.3 to 14.2%, five-year all-cause mortality from 41.7 to 34%, and CV mortality from 34.1 to 23.6%. The Czech Republic has witnessed a pronounced decrease in AMI incidence and fatality and, consequently, long-term mortality. The decreasing incidence and improving course of AMI are due to progress in primary prevention, in acute coronary care and interventional cardiology, and in secondary coronary heart disease (CHD) prevention.