Zaira Castañeda-Amado1, Lesly Calixto-Aguilar2, César Loza Munarriz3, Félix A Medina Palomino4. 1. Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú. Address: Avenida Honoro Delgado 430, Urbanización Ingeniería, Lima, Perú. Email: lesly.calixto.a@upch.pe. 2. Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú. 3. Unidad de Epidemiología Clínica, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú. 4. Unidad de Bienestar y Desarrollo del Recurso Humano y Docente, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú.
Abstract
INTRODUCTION: Cardiovascular disease is the leading cause of mortality worldwide. When an acute myocardial infarction occurs, it is necessary to establish secondary prevention measures, which can reduce mortality by 50%. Clinical guidelines state that the optimal medical treatment is based upon four groups of drugs: antiplatelet drugs, statins, beta-blockers and angiotensin-converting-enzyme inhibitor or angiotensin II receptor antagonist. OBJECTIVE: To determine physician compliance to evidence-based clinical practice guidelines on secondary prevention of coronary heart disease. METHODS: Retrospective, observational study in Hospital Cayetano Heredia in Lima, Peru. The study included patients with confirmed acute coronary syndrome from February 2011 to February 2013. Medical records, laboratory results and medical therapy at discharge were collected and were compared to the American Heart Association type I, evidence level A recommendations. In addition, patient follow-up visits to the outpatient cardiology clinic at 1, 3 and 6 months after discharge were analyzed. RESULTS: The study population included 143 patients. Eighty-nine (89) patients were admitted with the diagnosis of unstable angina and non-ST-segment elevation (62.2%) and 54 had ST-segment elevation myocardial infarction (37.8%). Forty patients (28%) received all four recommended medications at discharge, which decreased at 1, 3 and 6 months after discharge to 12.6%, 7% and 3.5% respectively. The results showed a significant reduction in patient compliance to follow-up visits with a 48% reduction at the first visit to 10% on the last visit. CONCLUSION: Medical compliance to guidelines recommendations in secondary cardiovascular prevention is suboptimal with a compliance score under 50%.
INTRODUCTION: Cardiovascular disease is the leading cause of mortality worldwide. When an acute myocardial infarction occurs, it is necessary to establish secondary prevention measures, which can reduce mortality by 50%. Clinical guidelines state that the optimal medical treatment is based upon four groups of drugs: antiplatelet drugs, statins, beta-blockers and angiotensin-converting-enzyme inhibitor or angiotensin II receptor antagonist. OBJECTIVE: To determine physician compliance to evidence-based clinical practice guidelines on secondary prevention of coronary heart disease. METHODS: Retrospective, observational study in Hospital Cayetano Heredia in Lima, Peru. The study included patients with confirmed acute coronary syndrome from February 2011 to February 2013. Medical records, laboratory results and medical therapy at discharge were collected and were compared to the American Heart Association type I, evidence level A recommendations. In addition, patient follow-up visits to the outpatient cardiology clinic at 1, 3 and 6 months after discharge were analyzed. RESULTS: The study population included 143 patients. Eighty-nine (89) patients were admitted with the diagnosis of unstable angina and non-ST-segment elevation (62.2%) and 54 had ST-segment elevation myocardial infarction (37.8%). Forty patients (28%) received all four recommended medications at discharge, which decreased at 1, 3 and 6 months after discharge to 12.6%, 7% and 3.5% respectively. The results showed a significant reduction in patient compliance to follow-up visits with a 48% reduction at the first visit to 10% on the last visit. CONCLUSION: Medical compliance to guidelines recommendations in secondary cardiovascular prevention is suboptimal with a compliance score under 50%.