Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)

Abstract

BackgroundStudying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.MethodsWe studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.ResultsBetween 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.ConclusionsDespite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys

“…Secondly, comparability between the studies (EA-IV and EA-V) is limited due to different inclusion criteria regarding the time between the index event and study examinations. A previous study with similar inclusion criteria as the EA studies, has demonstrated that outpatients after an acute event are more likely to reach risk factor targets compared to patients with history of an elective CABG or PCI [ 39 ]. However, as guidelines on secondary prevention recommend similar risk factor targets for all chronic CHD patients, and secondary prevention is a continuous process not limited by time, comparison of the presented data might be justified.…”

Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study

“…Cardiac rehabilitation (CR) is a class 1 level A recommendation for coronary heart disease (CHD) and heart failure patients, with benefits including reduced cardiovascular disease (CVD) mortality, morbidity and improved quality of life 1 2. However, despite this compelling evidence, data from the EuroAspire V and IAspire surveys indicate that CR utilisation rates across Europe are suboptimal 3 4. Indeed, the majority of CHD patients at pan-European and national levels are not meeting the recommended lifestyle, medical and therapeutic targets 3 4.…”

“…However, despite this compelling evidence, data from the EuroAspire V and IAspire surveys indicate that CR utilisation rates across Europe are suboptimal 3 4. Indeed, the majority of CHD patients at pan-European and national levels are not meeting the recommended lifestyle, medical and therapeutic targets 3 4. These challenges have only been exacerbated by the COVID-19 pandemic.…”

Exploring patient experiences of participating in digital cardiac rehabilitation: A qualitative study

“…For this reason, CR participation following a cardiovascular event is a class 1A recommendation of the American Heart Association (AHA), the American College of Cardiology and the European Society of Cardiology (Ambrosetti et al, 2020; Drozda et al, 2011). Despite its effectiveness, participation in CR is poor with less than half of eligible coronary patients participating in CR after an acute event (Curneen et al, 2021; Kotseva et al, 2018). Several factors contribute to the poor participation at CR, including lack of referral from healthcare providers, distance from the centre, lack of transport, work or family commitments, and inconvenient timing of the programme (De Vos et al, 2013; Resurrección et al, 2019).…”