Unfavourable risk factor control after coronary events in routine clinical practice

Abstract

BackgroundRisk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event.MethodsA cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up.ResultsTwenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed.ConclusionsThe majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits.Trial registrationRegistered at ClinicalTrials.gov (ID NCT02309255).Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0387-z) contains supplementary material, which is available to authorized users.

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study

“…In an Italian survey on Cardiac Rehabilitation and Secondary Prevention after Cardiac Revascularization, younger age was a predictor of smoking again after quitting, and older patients with comorbidity tended to persist in a sedentary lifestyle and poor diet after coronary revascularization [ 41 ]. In the Norwegian Coronary Prevention Study, current smoking was significantly more frequent in younger patients, and current smoking and low physical activity were significantly higher in females than in males after coronary artery disease [ 24 ].…”

Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention

“…In addition to medical treatment, patients need to know what is wrong or how to stay well, what is likely to happen and how the cardiac diseases will affect them, in a language they understand [26]. However, most patients do not receive treatment according to standard guidelines for secondary prevention [4,27]. The short hospital stay that is common in modern cardiac care makes it difficult to conduct inpatient education and training [3].…”

Forebyggende legemidler etter hjerteinfarkt utlevert fra apotek

“…Likevel viser store internasjonale studier at flertallet av pasientene med kransåresykdom ikke når anbefalte behandlingsmål for sekundaerforebygging (røykeslutt, blodtrykk < 140/90 mm Hg, LDL-kolesterol < 1,8 mmol/l, kroppsmasseindeks < 25 kg/m 2 samt fast bruk av acetylsalisylsyre og statin) (9). Tilsvarende resultater er nylig vist fra Norge (11,18). Mulige årsaker til dette kan vaere manglende forskriving av anbefalte legemidler etter hjerteinfarkt, manglende etterlevelse av anbefalingene, manglende effekt av behandlingstiltak (livsstilstintervensjon og legemidler) og mangelfull oppfølging fra helsevesenet etter utskriving fra sykehus.…”