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Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey
Affiliations- I Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Mossakowski Medical Research Centre, Polish Academy of Science, Warsaw, Poland
- Department of Cardiology and Hypertension with the Electrophysiological Lab, Central Research Hospital the Ministry of The Interior and Administration, Warsaw, Poland
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
- Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland
- Department of Public Health and Primary Care, Ghent University, Belgium
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London and National Institute of Preventive Cardiology, National University of Ireland-Galway, Galway, Ireland
- Department of Clinical Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD.
Methods: Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after the hospitalization.
Results: Overall, 947 patients were examined 6–18 months after hospitalization. The proportion of patients
with high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6–18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140/90 mmHg, LDL-C < 1.8 mmol/L and glucose < 7.0 mmol/L, body mass index < 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled.
Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational.
Abstract
Background: The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD.
Methods: Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6–18 months after the hospitalization.
Results: Overall, 947 patients were examined 6–18 months after hospitalization. The proportion of patients
with high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6–18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140/90 mmHg, LDL-C < 1.8 mmol/L and glucose < 7.0 mmol/L, body mass index < 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled.
Conclusions: The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational.
Keywords
coronary artery disease, risk factors, secondary prevention, smoking, hypertension, hypercholesterolemia
About this articleTitle
Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey
Journal
Issue
Pages
533-540
Published online
2020-05-20
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1874
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1224
DOI
Pubmed
Bibliographic record
Cardiol J 2020;27(5):533-540.
Keywords
coronary artery disease
risk factors
secondary prevention
smoking
hypertension
hypercholesterolemia
Authors
Piotr Jankowski
Dariusz A. Kosior
Paweł Sowa
Karolina Szóstak-Janiak
Paweł Kozieł
Agnieszka Krzykwa
Emilia Sawicka
Maciej Haberka
Małgorzata Setny
Karol Kamiński
Zbigniew Gąsior
Aldona Kubica
Dirk De Bacquer
Guy De Backer
Kornelia Kotseva
David Wood
Andrzej Pająk
Danuta Czarnecka
References (25)- GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392: 1736–1788.
- Gierlotka M, Zdrojewski T, Wojtyniak B, et al. Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009–2012 — nationwide AMI-PL database. Kardiol Pol. 2015: 142–158.
- Jankowski P, Gąsior M, Gierlotka M, et al. Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System. Kardiol Pol. 2016: 800–811.
- Kotseva K, Wood D, Bacquer DDe, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2015; 23(6): 636–648.
- Kotseva K, Backer GDe, Bacquer DDe, et al. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol. 2019; 26(8): 824–835.
- Jankowski P, Czarnecka D, Badacz L, et al. Practice setting and secondary prevention of coronary artery disease. Arch Med Sci. 2018; 14(5): 979–987.
- Kilic S, Sümerkan M, Emren V, et al. Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study. Cardiol J. 2019; 26(1): 13–19.
- Kotseva K, Bacquer DDe, Jennings C, et al. Time Trends in Lifestyle, Risk Factor Control, and Use of Evidence-Based Medications in Patients With Coronary Heart Disease in Europe: Results From 3 EUROASPIRE Surveys, 1999–2013. Global Heart. 2017; 12(4): 315.
- Piepoli M, Hoes A, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. 2016; 23(11): NP1–NP96.
- Banach M, Jankowski P, Jóźwiak J, et al. PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016. Arch Med Sci. 2017; 1: 1–45.
- Jankowski P, Kawecka-Jaszcz K, Kopeć G, et al. Polish forum for prevention guidelines on smoking: update 2017. Kardiol Pol. 2017: 409–411.
- Czarnecka D, Jankowski P, Kopeć G, et al. Polish Forum for Prevention Guidelines on Hypertension: update 2017. Kardiol Pol. 2017: 282–285.
- Gasior M, Gierlotka M, Pyka Ł, et al. Temporal trends in secondary prevention in myocardial infarction patients discharged with left ventricular systolic dysfunction in Poland. Eur J Prev Cardiol. 2018; 25(9): 960–969.
- Szychta W, Majstrak F, Opolski G, et al. Trends in pharmacological therapy of patients referred for coronary artery bypass grafting between 2004 and 2008: a single-centre study. Kardiol Pol. 2015: 1317–1326.
- Jankowski P, Czarnecka D, Łysek R, et al. Secondary prevention in patients after hospitalisation due to coronary artery disease: what has changed since 2006? Kardiol Pol. 2014: 355–362.
- Jankowski P, Czarnecka D, Wolfshaut-Wolak R, et al. Secondary prevention of coronary artery disease in contemporary clinical practice. Cardiol J. 2015; 22(2): 219–226.
- Parma Z, Young R, Roleder T, et al. Management strategies and 5-year outcomes in Polish patients with stable coronary artery disease in the CLARIFY registry versus other European countries. Pol Arch Intern Med. 2019.
- Piwońska A, Piotrowski W, Kozela M, et al. Cardiovascular diseases prevention in Poland: results of WOBASZ and WOBASZ II studies. Kardiol Pol. 2018: 1534–1541.
- Radzimanowski M, Gallowitz C, Müller-Nordhorn J, et al. Physician specialty and long-term survival after myocardial infarction — A study including all German statutory health insured patients. Int J Cardiol. 2018; 251: 1–7.
- Murphy E, Vellinga A, Byrne M, et al. Primary care organisational interventions for secondary prevention of ischaemic heart disease: a systematic review and meta-analysis. Br J Gen Pract. 2015; 65(636): e460–e468.
- Feusette P, Gierlotka M, Krajewska-Redelbach I, et al. Comprehensive coordinated care after myocardial infarction (KOS‑Zawał): a patient’s perspective. Kardiol Pol. 2019; 77(5): 568–570.
- Huber C, Meyer M, Steffel J, et al. Post-myocardial infarction (MI) care: medication adherence for secondary prevention after MI in a large real-world population. Clin Ther. 2019; 41(1): 107–117.
- Kubica A, Obońska K, Kasprzak M, et al. Prediction of high risk of non-adherence to antiplatelet treatment. Kardiol Pol. 2015: 61–67.
- Swieczkowski D, Mogielnicki M, Cwalina N, et al. Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications. Cardiol J. 2013.
- Kubica A, Kasprzak M, Obonska K, et al. Discrepancies in assessment of adherence to antiplatelet treatment after myocardial infarction. Pharmacology. 2015; 95(1-2): 50–58.
