Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study

Ferrières, Jean; Lautsch, Dominik; Ambegaonkar, Baishali; Ferrari, Gaetano M. De; Vyas, Ami; Baxter, Carl A.; Bash, Lori D.; Velkovski-Rouyer, Maja; Horack, Martin; Almahmeed, Wael; Chiang, Fu Tien; Poh, Kian Keong; Elisaf, Moses; Brudi, Philippe; Gitt, Anselm K.

doi:10.1016/j.ijcard.2018.06.008

Cited by 15 publications

(17 citation statements)

References 48 publications

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“…Primary prevention of stroke involves both screening for and treatment of major risk factors including hypertension, AF, arteriosclerotic artery disease, elevated blood cholesterol levels as well as lifestyle factors such as smoking, alcohol, physical inactivity or obesity; and other risk factors such as diabetes mellitus, health related quality of life, or a family history of stroke or AF. 6 Poor control of these risk factors has been reported in general populations, 7 as well as in patients with ischaemic stroke. Gender differences in stroke are incompletely understood, low testosterone levels have been observed with increased risk of AF and hence ischaemic stroke in men but not in women.…”

Section: Causality Prevention and Risk Factor Managementmentioning

confidence: 99%

Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

Doehner

Mazighi

Hofmann

et al. 2019

Eur J Prev Cardiolog

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Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short-and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.

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Section: Causality Prevention and Risk Factor Managementmentioning

confidence: 99%

Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

Doehner

Mazighi

Hofmann

et al. 2019

Eur J Prev Cardiolog

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“…We found one prior study, by Ferrières et al, which also evaluated differences in preventive care on the basis of CHD presentation type. 17 However, among those with ACS, the authors looked at differences in the intensity of secondary prevention medications at discharge from the hospital. By contrast, iASPIRE studied the intensity of secondary prevention among ACS and stable-CCS outpatients approximately a year after their index CHD presentation; which is sufficient time for the healthcare system to get these patients to recommended risk factor targets.…”

Section: Discussionmentioning

confidence: 99%

Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)

et al. 2021

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BackgroundStudying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.MethodsWe studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.ResultsBetween 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.ConclusionsDespite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.

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“…Thus, such patients more frequently receive cessation interventions from clinicians. Moreover, clinical guidelines on chronic diseases such as COPD 20 , coronary heart disease 21 , and hypertension 22 recommend that HPs should proactively deliver cessation interventions to smoking patients. Therefore, HPs generally pay more attention to the smoking patients with chronic diseases and are more proactive in providing smoking cessation interventions to them.…”

Section: Discussionmentioning

confidence: 99%

Patients’ self-reported receipt of brief smoking cessation interventions based on a decision support tool embedded in the healthcare information system of a large general hospital in China

Chu¹,

Liang²,

Jing³

et al. 2019

Tob. Induc. Dis.

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INTRODUCTIONHealthcare information systems (HIS) are used to aid healthcare providers delivering brief smoking cessation interventions. However, evidence regarding the effectiveness of intervention models in developing countries remains limited. A smoking cessation intervention model based on a decision support tool embedded in HIS (an ‘e-information model’, including Ask, Advise, Assess, Inform, Refer and Print components) was applied in a large urban general hospital in Beijing, China. The current study was a preliminary evaluation of the implementation and effectiveness of this model.METHODSWe conducted a retrospective investigation in the outpatient department of the hospital in the period June–July 2017. Using a paper questionnaire, patients’ self-reported receipt of the e-information model in the past 2 months and their plans to quit within 1 month were collected. Multivariate logistic regression analysis was used to examine the association between receiving the e-information model and patients’ plans to quit.RESULTSAmong 656 currently smoking patients, the proportion of patients receiving the Ask, Advise, Assess, Refer and Print components were 73.2%, 65.4%, 49.8%, 16.0% and 10.4%, respectively. The results revealed a dose-response relationship between the number of components received and the proportion of patients planning to quit (p-trend=0.006). The likelihood of patients planning to quit within 1 month was highest among those receiving all five components (OR=2.79, 95% CI: 1.31–5.94). Moreover, a simplified model composed of two or three components also revealed a potential effect on increasing the proportion of patients planning to quit.CONCLUSIONSThe e-information model was applied effectively in the study hospital and appeared to encourage patients to plan to quit smoking. This model could be generalized to other hospitals in China and other developing countries. However, many components of this model were less utilized, and comprehensive measures will be required to improve its application in the future.

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Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study

Cited by 15 publications

References 48 publications

Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)

Patients’ self-reported receipt of brief smoking cessation interventions based on a decision support tool embedded in the healthcare information system of a large general hospital in China

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