Archives of cardiovascular diseases · 2015
Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Meurice Thibaud, Tricot Olivier, Lemesle Gilles, Deneve Michel, Lejeune Philippe, Biausque Frédéric, Cordier Christophe, Savoye Christine, Hennebert Olivier, Taghipour Kouroch, Sivery Bruno, Pruvost Philippe, Alaoui Moulay, Carpentier Laurent, Segrestin Benoit, Lamblin Nicolas, Bauters Christophe
Аннотация
BACKGROUND: In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome.
AIMS: To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD.
METHODS: We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing.
RESULTS: The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042).
CONCLUSIONS: Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.
AIMS: To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD.
METHODS: We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing.
RESULTS: The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042).
CONCLUSIONS: Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.
Предметные рубрики MeSH
Adrenergic beta-AntagonistsAgedAngiotensin II Type 1 Receptor BlockersAngiotensin-Converting Enzyme InhibitorsComorbidityCoronary DiseaseDiabetes MellitusDrug UtilizationEvidence-Based MedicineFemaleFibrinolytic AgentsFranceGuideline AdherenceHumansHypertensionKidney DiseasesMaleMiddle AgedMulticenter Studies as TopicMyocardial InfarctionMyocardial RevascularizationPractice Guidelines as TopicRecurrenceRisk FactorsSecondary PreventionTreatment Outcome