Variation in secondary prevention of coronary heart disease: the INTERASPIRE study.
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McEvoy John William, Jennings Catriona, Kotseva Kornelia, De Bacquer Dirk, De Backer Guy, Erlund Iris, Vihervaara Terhi, Lip Gregory Y H, Ray Kausik K, Rydén Lars, Abreu Ana, Almahmeed Wael, Ambari Ade Meidian, Ge Junbo, Hasan-Ali Hosam, Huo Yong, Jankowski Piotr, Jimenez Rodney M, Li Yong, Mahmood Zuhdi Ahmad Syadi, Makubi Abel, Mbakwem Amam Chinyere, Mbau Lilian, Navarro Estrada Jose Luis, Ogah Okechukwu Samuel, Ogola Elijah Nyainda, Quintero-Baiz Adalberto, Sani Mahmoud Umar, Sosa Liprandi Maria Ines, Tan Jack Wei Chieh, Urina Triana Miguel Alberto, Yeo Tee Joo, Ganly Sandra, Adamska Agnieszka, Wood David
Аннотация
METHODS: Between 2020 and 2023, adults hospitalized in the preceding 6-24 months with incident or recurrent CHD were sampled in 14 countries from all 6 World Health Organization regions and invited for a standardized interview and examination. Direct age and sex standardization was used for country-level prevalence estimation.
RESULTS: Overall, 4548 (21.1% female) CHD patients were interviewed a median of 1.05 (interquartile range .76-1.45) years after index hospitalization. Among all participants, 24.6% were obese (40.7% centrally). Only 38.6% achieved a blood pressure (BP) < 130/80 mmHg and 16.6% a LDL cholesterol (LDL-C) of <1.4 mmol/L. Of those smoking at hospitalization, 48% persisted at interview. Of those with known diabetes, 55.2% achieved glycated haemoglobin (HbA1c) of <7.0%. A further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. Females were less likely to achieve the targets: BP (females 36.8%, males 38.9%), LDL-C (females 12.0%, males 17.9%), and HbA1c in diabetes (females 47.7%, males 57.5%). Overall, just 9.0% (inter-country range 3.8%-20.0%) reported attending cardiac rehabilitation and 1.0% (inter-country range .0%-2.4%) achieved the study definition of optimal guideline adherence.
CONCLUSIONS: INTERASPIRE demonstrates inadequate and heterogeneous international implementation of guideline standards for secondary prevention in the first year after CHD hospitalization, with geographic and sex disparity. Investment aimed at reducing between-country and between-individual variability in secondary prevention will promote equity in global efforts to reduce the burden of CHD.