Management and clinical outcome of stable coronary artery disease in Austria

Abstract

SummaryBackgroundThe population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry.MethodsCLARIFY was an international prospective observational registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization (CABG or PCI), coronary stenosis of more than 50% by coronary angiography or chest pain with myocardial ischemia. We analyzed demographic characteristics, risk factors, treatments and clinical outcomes of 424 Austrian outpatients with established CAD who were enrolled between November 2009 and July 2010 and observed until September 2015.ResultsThe primary risk factors in Austrian outpatients with stable CAD were smoking (current smokers: 13.2%), overweight (77.1%), hypertension (78.5%), raised low-density lipoprotein (LDL) cholesterol plasma levels (81.4% ≥ 0.7 g/l or 1.8 mmol/l), elevated heart rate (≥70 bpm: 60.9% in patients with anginal symptoms) and poor physical activity (none or light activity: 63.4%). Patients received lipid-lowering drugs (predominantly statins), aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors according to current recommendations. After 5 years a systolic blood pressure (SBP) < 140 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg was reached in 58.5% of patients. Of the patients 70.4% had LDL cholesterol plasma levels below 1.0 g/l (2.6 mmol/l), 42.1% of smokers had stopped smoking, 42.9% of patients with anginal symptoms had a heart rate ≤60 bpm and 26.0% of diabetic patients had brought their HbA1c levels below 6.5%. Cardiovascular death, myocardial infarction or stroke occurred in 30 patients (7.1%), all-cause death in 25 cases (5.9%) and cardiovascular death in 15 cases (3.5%). Myocardial infarction was reported in 14 patients (fatal and non-fatal: 3.3%) and stroke in 8 patients (fatal and non-fatal: 1.9%), 39 patients (9.2%) underwent myocardial revascularization and 124 patients (29.2%) experienced cardiovascular hospitalization.ConclusionCharacteristics of Austrian outpatients with stable CAD corresponded to those of patients with CAD in other developed countries. Medical treatments following the recommendations of the European guidelines were prescribed in the majority of patients; however, recommended goals of life style interventions including a heart rate less than 60 bpm and general risk factor management were not achieved by a high proportion of patients. Heart rate control and life style changes remain unmet needs of cardiovascular care in Austria.

Ranolazine: impact on quality of life in patients with stable angina pectoris, results from an observational study in Austria – the ARETHA AT study

“…The ARETHA AT study focused on the situation of patients with stable angina in Austria. Demographic features were in good accordance with the results of a recent registry [ 6 ]. Austrian patients were not included in ranolazine registration studies and ARETHA AT patients differed by inclusion and exclusion criteria from the restrictions of controlled studies.…”

“…In Austria, which did not contribute to the pivotal ranolazine studies, failure and/or contraindication or intolerance towards CCBs and beta blockers are required to justify reimbursement of ranolazine by public health insurances [ 5 ]. According to registry data, ranolazine is used in up to 20% of the patients with stable coronary artery disease [ 6 ].…”

Functional status and life satisfaction of patients with stable angina pectoris in Austria

“…In order to keep the questionnaire as concise as possible, data on concurrent drug treatment, hospitalisations and disease burden, for example, by imaging, are missing. However, those can be expected to be following the guidelines as has been recently reported for the Austrian CAD population 26. This might also explain why approximately 49% of LENA sAP patients do report some disease improvement over the last 4 weeks, including potential seasonal variations, health modifications or adaptations in the medication (SAQ Part B in table 4), or why some LENA patients (38.9%) rated not to have any typical angina symptoms over the last 4 weeks (SAQ Part C, table 4).…”

Berberine Protects Against Simulated Ischemia/Reperfusion Injury-Induced H9C2 Cardiomyocytes Apoptosis In Vitro and Myocardial Ischemia/Reperfusion-Induced Apoptosis In Vivo by Regulating the Mitophagy-Mediated HIF-1α/BNIP3 Pathway

“…Coronary heart disease (CHD) has become the leading cause of human death, accounting for 13.2% of the top 10 causes (Lang et al, 2017). The most effective therapeutic intervention for CHD is timely and effective myocardial reperfusion.…”