Secondary prevention patterns in persons with pre-existing coronary artery disease: Are we getting it right?

Abstract

Background: Cardiovascular diseases are the main cause of death globally. Individuals with evidence of coronary artery disease are at increased risk of further cardiovascular events. However, with good secondary prevention, which consists broadly of lifestyle changes, medical therapy and revascularisation, this risk can be reduced. The true extent of secondary prevention in individuals who are re-admitted with a myocardial infarction in such a high-risk cohort has never been explored in Malaysia. Methods: We performed a retrospective, observational study in a tertiary hospital in 100 individuals with previously diagnosed coronary artery disease admitted with a myocardial infarction from August 2016 to February 2017. Results: Twenty-nine per cent of patients were still smoking; 15% and 47% were not taking antiplatelet or beta-blocker therapy, respectively. A further 45% and 20% of patients were not on any renin–angiotensin–aldosterone inhibition or lipid-lowering therapy, respectively. Conclusion: In our high-risk cohort, secondary prevention practices were sub-optimal. Poor physician–patient communication was frequently listed as a major factor. Simple strategies taken at various levels of care should be implemented and audited to improve these practices.

Prevalence of plasma lipid disorders with an emphasis on LDL cholesterol in selected countries in the Asia-Pacific region

“…Based on the studies above, there is a disconnect between the proportion of patients with known plasma lipid disorders, those treated, and those whose lipid levels are controlled. Although the use of lipid-lowering therapy is common across the Asia-Pacific region, it is not used to its full potential, especially in very high risk patients [ 52 , 60 ]. In order to develop more effective management strategies, a better understanding of the reasons for poor goal attainment is needed.…”

“…In the Philippines, some physicians in rural areas lack awareness of the latest clinical guidelines and/or trials and are thus less confident in prescribing higher-dose statins to patients. In Malaysia, suboptimal secondary prevention in patients with pre-existing coronary artery disease has been partly ascribed to poor physician prescribing patterns and patient compliance [ 60 ]. High workloads for GPs and primary care physicians in Malaysia can lead to rushed consultations, making the formation of partnerships between patients and physicians for the management of CV risk difficult.…”