Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey

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/m 2), 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.

Obesity in patients with established coronary artery disease over a 20-year period (1997–2017)

“…There is strong scientific evidence that the long-term survival of coronary patients may be improved by providing optimal cardiovascular prevention [8]. The increasing proportion of obese patients may be responsible for the increase in hypertension, dyslipidemia, and diabetes prevalence as well as for insufficient improvement in the control of these risk factors despite increase in the drugs prescription rates in patients with coronary artery disease [4,13,22]. The present results urge to improve cardiovascular prevention in patients with coronary artery disease.…”

“…We analyzed data of participants of five surveys assessing cardiovascular prevention following hospitalization due to CAD that were conducted in 1997-1998 (survey I), 1999-2000 (survey II), 2006-2007 (survey III), 2011-2013 (survey IV), and 2016-2017 (survey V) [9][10][11][12][13]. The same five hospitals serving the city and surrounding districts participated in each survey.…”

“…The same five hospitals serving the city and surrounding districts participated in each survey. The methods used in these surveys had been published previously and were similar on each occasion [9][10][11][12][13]. In brief, the study sample in each survey consisted of consecutive patients hospitalized for myocardial infarction, unstable angina, percutaneous coronary intervention, or coronary artery bypass grafting.…”

Pharmacotherapy in patients with chronic coronary syndromes over a 20-year period (1997–2017)

“…We analyzed data of participants of five surveys assessing secondary prevention following hospitalization due to CAD carried out in 1997-1998, 1999-2000, 2006-2007, 2011-2013, and 2016-2017 [8][9][10][11][12]. The same five hospitals serving the city and surrounding districts participated in each survey.…”

“…The same five hospitals serving the city and surrounding districts participated in each survey. Methods used in surveys were published previously and were similar each time [8][9][10][11][12][13]. Shortly, in each survey the study sample consisted of consecutive patients hospitalized for coronary artery bypass grafting or percutaneous coronary intervention or myocardial infarction or unstable angina.…”