Martin Wagner1,2,3, Götz Gelbrich4, Julia Kircher4,5, Kornelia Kotseva6,7, David Wood6, Caroline Morbach5,7, Rainer Leyh5,8, Georg Ertl5,7, Wolfgang Karmann9, Stefan Störk5,10, Peter U Heuschmann4,5,11. 1. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany. wagner_m@ukw.de. 2. Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. wagner_m@ukw.de. 3. Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. wagner_m@ukw.de. 4. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080, Würzburg, Germany. 5. Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. 6. Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. 7. Department of Public Health, University of Ghent, Ghent, Belgium. 8. Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany. 9. Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany. 10. Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany. 11. Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany.
Abstract
PURPOSE: Evidence is limited on implementation of secondary prevention guidelines for coronary heart disease (CHD) in clinical practice and variations between younger and elder patients. We investigated the control of cardiovascular risk factors in German patients with CHD enrolled in the European-wide EUROASPIRE IV survey, stratified by younger (18-69 years) and older (70-79 years) age groups. METHOD: Eligible subjects were identified via the hospitals' patient information system and invited to attend a study visit 6 months to 3 years after hospitalization for CHD (myocardial infarction, ischemia, angioplasty/stent, coronary bypass grafting). Information on lifestyle and medication was collected by interview. RESULTS: Five hundred thirty-six patients were recruited in 2012-2013 (median age 69 years [IQR 62-74 years], 18% female, 44% ≥ 70 years of age, median time between index hospitalization and study visit 1.8 [1.1-2.5] years). Proportion of CHD patients receiving recommended drug therapy was 89% for platelet inhibitors (younger vs. older patients 93 vs. 84%, p < 0.01), 83% for statins (83 vs. 85%, p = 0.9), and 83% for beta-blockers (87 vs. 79%, p = 0.02). Uncontrolled blood pressure was observed in 45% (40 vs. 50%, p = 0.02), LDL cholesterol levels > 2.5 mmol/l in 53% (56 vs. 49%, p = 0.1), and HbA1c levels > 7% in diabetic patients in 39% (45 vs. 32%, p = 0.1). Eighty-five percent were overweight (86 vs. 85%, p = 0.8), 37% were obese (41 vs. 31%, p = 0.01), and 10% reported currently smoking (17 vs. 3%, p < 0.01). CONCLUSION: Although most CHD patients received the drug classes recommended by guidelines, treatment goals were frequently not achieved. Elderly subjects had a less favorable pattern, which may reflect multi-morbidity and weaker identification with treatment targets. National CHD prevention strategies should focus not only on enhancing lifestyle modifications and reaching treatment targets, but also on highlighting the different needs in older individuals.
PURPOSE: Evidence is limited on implementation of secondary prevention guidelines for coronary heart disease (CHD) in clinical practice and variations between younger and elder patients. We investigated the control of cardiovascular risk factors in German patients with CHD enrolled in the European-wide EUROASPIRE IV survey, stratified by younger (18-69 years) and older (70-79 years) age groups. METHOD: Eligible subjects were identified via the hospitals' patient information system and invited to attend a study visit 6 months to 3 years after hospitalization for CHD (myocardial infarction, ischemia, angioplasty/stent, coronary bypass grafting). Information on lifestyle and medication was collected by interview. RESULTS: Five hundred thirty-six patients were recruited in 2012-2013 (median age 69 years [IQR 62-74 years], 18% female, 44% ≥ 70 years of age, median time between index hospitalization and study visit 1.8 [1.1-2.5] years). Proportion of CHD patients receiving recommended drug therapy was 89% for platelet inhibitors (younger vs. older patients 93 vs. 84%, p < 0.01), 83% for statins (83 vs. 85%, p = 0.9), and 83% for beta-blockers (87 vs. 79%, p = 0.02). Uncontrolled blood pressure was observed in 45% (40 vs. 50%, p = 0.02), LDL cholesterol levels > 2.5 mmol/l in 53% (56 vs. 49%, p = 0.1), and HbA1c levels > 7% in diabeticpatients in 39% (45 vs. 32%, p = 0.1). Eighty-five percent were overweight (86 vs. 85%, p = 0.8), 37% were obese (41 vs. 31%, p = 0.01), and 10% reported currently smoking (17 vs. 3%, p < 0.01). CONCLUSION: Although most CHD patients received the drug classes recommended by guidelines, treatment goals were frequently not achieved. Elderly subjects had a less favorable pattern, which may reflect multi-morbidity and weaker identification with treatment targets. National CHD prevention strategies should focus not only on enhancing lifestyle modifications and reaching treatment targets, but also on highlighting the different needs in older individuals.
Authors: Todd M Brown; Luqin Deng; David J Becker; Vera Bittner; Emily B Levitan; Robert S Rosenson; Monika M Safford; Paul Muntner Journal: Am Heart J Date: 2015-05-02 Impact factor: 4.749
Authors: Christof Prugger; Jan Heidrich; Jürgen Wellmann; Ralf Dittrich; Stefan-Martin Brand; Ralph Telgmann; Günter Breithardt; Holger Reinecke; Hans Scheld; Peter Kleine-Katthöfer; Peter U Heuschmann; Ulrich Keil Journal: Dtsch Arztebl Int Date: 2012-04-27 Impact factor: 5.594
Authors: Frederick A Masoudi; Pam Wolfe; Edward P Havranek; Saif S Rathore; JoAnne M Foody; Harlan M Krumholz Journal: J Am Coll Cardiol Date: 2005-09-20 Impact factor: 24.094
Authors: Kornelia Kotseva; David Wood; Guy De Backer; Dirk De Bacquer; Kalevi Pyörälä; Ulrich Keil Journal: Lancet Date: 2009-03-14 Impact factor: 79.321
Authors: Kornelia Kotseva; David Wood; Guy De Backer; Dirk De Bacquer; Kalevi Pyörälä; Ulrich Keil Journal: Eur J Cardiovasc Prev Rehabil Date: 2009-04
Authors: Rafael Lozano; Mohsen Naghavi; Kyle Foreman; Stephen Lim; Kenji Shibuya; Victor Aboyans; Jerry Abraham; Timothy Adair; Rakesh Aggarwal; Stephanie Y Ahn; Miriam Alvarado; H Ross Anderson; Laurie M Anderson; Kathryn G Andrews; Charles Atkinson; Larry M Baddour; Suzanne Barker-Collo; David H Bartels; Michelle L Bell; Emelia J Benjamin; Derrick Bennett; Kavi Bhalla; Boris Bikbov; Aref Bin Abdulhak; Gretchen Birbeck; Fiona Blyth; Ian Bolliger; Soufiane Boufous; Chiara Bucello; Michael Burch; Peter Burney; Jonathan Carapetis; Honglei Chen; David Chou; Sumeet S Chugh; Luc E Coffeng; Steven D Colan; Samantha Colquhoun; K Ellicott Colson; John Condon; Myles D Connor; Leslie T Cooper; Matthew Corriere; Monica Cortinovis; Karen Courville de Vaccaro; William Couser; Benjamin C Cowie; Michael H Criqui; Marita Cross; Kaustubh C Dabhadkar; Nabila Dahodwala; Diego De Leo; Louisa Degenhardt; Allyne Delossantos; Julie Denenberg; Don C Des Jarlais; Samath D Dharmaratne; E Ray Dorsey; Tim Driscoll; Herbert Duber; Beth Ebel; Patricia J Erwin; Patricia Espindola; Majid Ezzati; Valery Feigin; Abraham D Flaxman; Mohammad H Forouzanfar; Francis Gerry R Fowkes; Richard Franklin; Marlene Fransen; Michael K Freeman; Sherine E Gabriel; Emmanuela Gakidou; Flavio Gaspari; Richard F Gillum; Diego Gonzalez-Medina; Yara A Halasa; Diana Haring; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Bruno Hoen; Peter J Hotez; Damian Hoy; Kathryn H Jacobsen; Spencer L James; Rashmi Jasrasaria; Sudha Jayaraman; Nicole Johns; Ganesan Karthikeyan; Nicholas Kassebaum; Andre Keren; Jon-Paul Khoo; Lisa Marie Knowlton; Olive Kobusingye; Adofo Koranteng; Rita Krishnamurthi; Michael Lipnick; Steven E Lipshultz; Summer Lockett Ohno; Jacqueline Mabweijano; Michael F MacIntyre; Leslie Mallinger; Lyn March; Guy B Marks; Robin Marks; Akira Matsumori; Richard Matzopoulos; Bongani M Mayosi; John H McAnulty; Mary M McDermott; John McGrath; George A Mensah; Tony R Merriman; Catherine Michaud; Matthew Miller; Ted R Miller; Charles Mock; Ana Olga Mocumbi; Ali A Mokdad; Andrew Moran; Kim Mulholland; M Nathan Nair; Luigi Naldi; K M Venkat Narayan; Kiumarss Nasseri; Paul Norman; Martin O'Donnell; Saad B Omer; Katrina Ortblad; Richard Osborne; Doruk Ozgediz; Bishnu Pahari; Jeyaraj Durai Pandian; Andrea Panozo Rivero; Rogelio Perez Padilla; Fernando Perez-Ruiz; Norberto Perico; David Phillips; Kelsey Pierce; C Arden Pope; Esteban Porrini; Farshad Pourmalek; Murugesan Raju; Dharani Ranganathan; Jürgen T Rehm; David B Rein; Guiseppe Remuzzi; Frederick P Rivara; Thomas Roberts; Felipe Rodriguez De León; Lisa C Rosenfeld; Lesley Rushton; Ralph L Sacco; Joshua A Salomon; Uchechukwu Sampson; Ella Sanman; David C Schwebel; Maria Segui-Gomez; Donald S Shepard; David Singh; Jessica Singleton; Karen Sliwa; Emma Smith; Andrew Steer; Jennifer A Taylor; Bernadette Thomas; Imad M Tleyjeh; Jeffrey A Towbin; Thomas Truelsen; Eduardo A Undurraga; N Venketasubramanian; Lakshmi Vijayakumar; Theo Vos; Gregory R Wagner; Mengru Wang; Wenzhi Wang; Kerrianne Watt; Martin A Weinstock; Robert Weintraub; James D Wilkinson; Anthony D Woolf; Sarah Wulf; Pon-Hsiu Yeh; Paul Yip; Azadeh Zabetian; Zhi-Jie Zheng; Alan D Lopez; Christopher J L Murray; Mohammad A AlMazroa; Ziad A Memish Journal: Lancet Date: 2012-12-15 Impact factor: 79.321
Authors: S Störk; P U Heuschmann; K Ungethüm; S Wiedmann; M Wagner; R Leyh; G Ertl; S Frantz; T Geisler; W Karmann; R Prondzinsky; C Herdeg; M Noutsias; T Ludwig; J Käs; B Klocke; J Krapp; D Wood; K Kotseva Journal: Clin Res Cardiol Date: 2022-09-27 Impact factor: 6.138
Authors: Peter R Sinnaeve; Gregory G Schwartz; Daniel M Wojdyla; Marco Alings; Deepak L Bhatt; Vera A Bittner; Chern-En Chiang; Roger M Correa Flores; Rafael Diaz; Maria Dorobantu; Shaun G Goodman; J Wouter Jukema; Yong-Un Kim; Robert Pordy; Matthew T Roe; Rody G Sy; Michael Szarek; Harvey D White; Andreas M Zeiher; Ph Gabriel Steg Journal: Eur Heart J Date: 2020-06-21 Impact factor: 29.983