Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland

Abstract

Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients (n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.

Compliance to secondary prevention strategies for coronary artery disease: a hospital-based cross-sectional survey from Ernakulam, South India

“…Similar low adoption of regular LDL screening among patients with CAD was reported from Finland. 32 Regular screening for adequate diabetic control among patients with CAD and with diabetes appears to be on the lower side (60%) in the current study. Among those who were screened, only one in two demonstrated adequate diabetic control (HbA1C <7%) which is similar to that reported by Euroaspire V. The risk for coronary events among those with diabetes are known to decrease with older age.…”

Risk-stratified analysis of long-term clinical outcomes and cumulative costs in Finnish patients with recent acute coronary syndrome or coronary revascularization: a 5-year real-world study using electronic health records

“…The incidence of ACS and/or coronary revascularization patients was in line with earlier research conducted in the same area. 14 The observed 5-year cumulative incidence of recurrent events, based on the baseline SMART-REACH risk quintiles, varied from 20% to 41%. These results are similar to a previous study in the USA, where the average event rate at the 5-year time point was, on average, 33.4%, but with a slightly different definition of a recurrent event.…”

“…Annually, approximately 600–700 new ACS and/or coronary revascularization cases are recorded in the North Karelia Wellbeing Services County. 14 …”

Fast travel-distance estimation using overhead graph

“…The selected data were originally used for other research purposes and includes mainly patients with alcohol-use disorder (Rautiainen, Ryynänen, and Laatikainen 2018), type 2 diabetes (Toivakka et al 2018), coronary heart disease (Repo et al 2018) and anticoagulation (Leminen et al 2019). The data is therefore not an exact representation of the entire population, but its geographic distribution is rather similar, and it is useful for our study.…”