Differences in Medical Treatment of Chronic Coronary Heart Disease Patients According to Medical Specialities

Abstract

Coronary heart disease (CHD) patients are currently attended by many different medical specialities. CHD patients must achieve the highest grade of treatment implementation and risk factors control. The aims were to describe differences in medical treatment of CHD according to the medical specialities. For this purpose we conducted an observational, cross-sectional, and multicenter study of CHD patients attended by internal medicine (IM), outpatient clinic cardiologist (OCC), hospital cardiologist (HC), and general practitioners (PC). Burden of noncardiac diseases was evaluated by the Charlson index. Joint prescription of antiplatelets, statins, beta-blockade agents and blockade of the renin-angiotensin system by angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptors blockers (ARB) was considered optimal medical treatment (OMT). A total of 2987 patients, mean age 67.4 (11.5) years and 71.5% males, were analyzed. Patients visited by IM physicians had slightly higher mean age and higher prevalence of hypertension, diabetes, and noncardiac diseases (median Charlson index 3.0, 1.0-5.0, vs. 2.0, 1.0-4.0, of total sample). OMT was prescribed in 25.9% (95% CI 25.6-26.2) of the patients and was statistically more frequently carried out by HC (32.1%) and OCC (29.0%) compared to IM (22.0%) and PC practitioners (21.5%). Multivariate analysis showed an independent association between OMT prescription and HC (OR 1.42; 95% CI 1.08-1.87) or OCC (OR 1.31; 95% CI 1.04-1.67); this association remained after including the Charlson index. Noncardiac diseases are the main clinical differences in CHD patients visited by different medical specialist although it does not explain the higher prescription of OMT by cardiologist.

Differential Effect of β‐Blockers for Heart Rate Control in Coronary Artery Disease

“…In fact, only 56% of the patients of our study were receiving a BB, and myocardial infarction was present in more than 40% and heart failure in almost a fifth of the whole sample. These results bring to light the low use of BBs in a large sample of CHD patients and agrees with other registries, 24,25,29,30 although none of them analyzed RHR. We also obtained nearly-significant interactions between BB use and the antecedent of myocardial infarction or atrial fibrillation, which could affect the association of BBs with RHR control.…”

“…23 The TRECE registry (TRatamiento de la EnfermedadCoronaria en España [Treatment of coronary artery disease in Spain]) was designed to describe the current treatments of CAD patients to identify the most frequent limitations or failures in optimal treatment achievement. 24,25 The present subanalysis aimed to describe RHR control in CAD patients under 2 major hypotheses: first, that RHR is poorly controlled in daily practice, and second, a differential effect of BB in RHR could exist.…”

“…24,25 Throughout the first 3 months of 2006, each investigator included 15 consecutive patients with CAD, therefore a total of 3000 patients constituted the initial database. After exclusion of patients with missing data, a final population of 2897 patients was analyzed.…”

Should health insurers target prevention of cardiovascular disease?: a cost-effectiveness analysis of an individualised programme in Germany based on routine data

“…These could be achieved through the leading role of cardiologists in the programme. Cardiologists have not only been shown to be more effective in the treatment of coronary patients, compared with general practitioners and internists [22,23], they have also been advised to precisely follow evidence-based treatment guidelines, which are currently not followed sufficiently in Germany [24]. This may explain the strong health effect in subgroups at high cardiovascular baseline risk.…”

Improving Cardiovascular Protection: Focus On a Cardiovascular Polypill

“…Thus, these studies showed that approximately 3-12% of patients were not taking antiplatelets, 17-33% were not receiving β-blockers, 22-30% ACEi or ARB, and 7-28% statins (Figure 2) [11,12,15,35]. In addition, there are relevant differences regarding medical treatment of patients with chronic coronary heart disease according to clinical management by different specialists [36]. This undertreatment may also be explained by both, an underestimation of cardiovascular risk [37,38], and an incorrect perception of risk factors control rates [12,39].…”