Jean Ferrières1, Dominik Lautsch2, Baishali M Ambegaonkar2, Gaetano M De Ferrari3, Ami Vyas4, Carl A Baxter5, Lori D Bash2, Maja Velkovski-Rouyer6, Martin Horack7, Wael Almahmeed8, Fu-Tien Chiang9, Kian Keong Poh10, Moses Elisaf11, Philippe Brudi2, Anselm K Gitt12. 1. Department of Cardiology, Toulouse Rangueil University Hospital (CHU), Toulouse, France; Department of Epidemiology and Public Health, UMR INSERM 1027, INSERM - Université de Toulouse, Toulouse, France. Electronic address: jean.ferrieres@univ-tlse3.fr. 2. Merck & Co., Inc., Kenilworth, NJ, USA. 3. Department of Cardiology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy. 4. Rutgers University, School of Public Health, Piscataway, NJ, USA. 5. MSD Ltd, Hoddesdon, UK. 6. MSD France, Paris, France. 7. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. 8. Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates. 9. National Taiwan University Hospital, Taipei, Taiwan. 10. Yong Loo Lin School of Medicine, National University Heart Center, Singapore, Singapore. 11. School of Medicine, University of Ioannina, Ioannina, Greece. 12. Herzzentrum Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany.
Abstract
BACKGROUND: Guidelines recommend lifestyle modification and medications to control risk factors in coronary heart disease (CHD). Using data from the observational DYSIS II study, we sought to evaluate the use of guideline-recommended treatments at discharge for acute coronary syndromes (ACS) or in the chronic phase for CHD, and participation in rehabilitation/secondary prevention programs. METHODS AND RESULTS: Between 2013 and 2014, 10,661 patients (3867 with ACS, 6794 with stable CHD) were enrolled in 332 primary and secondary care centers in 18 countries (Asia, Europe, Middle East). Patients with incident ACS were younger and more likely to be smokers than patients with recurrent ACS or stable CHD (both p < 0.0001). Sedentary lifestyle was common (44.4% of ACS patients; 44.2% of stable CHD patients); 22.8% of ACS patients and 24.3% of stable CHD patients were obese. Prevalence of low high-density lipoprotein cholesterol (<40 mg/dL in men/50 mg/dL in women) was 46.9% in chronic CHD and 55.0% in ACS. Rates of secondary prevention medications were lower among CHD versus ACS (all p < 0.0001): antiplatelet 94.3% vs 98.0%, beta-blocker 72.0% vs 80.0%, lipid-lowering therapy 94.7 vs 97.5%, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 69.4% vs 73.7%, respectively. Attendance at cardiac rehabilitation (16.8% of patients with a first ACS, 10.8% with recurrent ACS) or a secondary prevention program (3.7% of ACS and 11.7% of stable CHD patients) was infrequent. CONCLUSIONS: The high prevalence of risk factors in all CHD patients and reduced rates of secondary prevention medications in stable CHD offer areas for improvement. TRANSLATIONAL ASPECTS: The findings of DYSIS II may reinforce the importance of adopting a healthy lifestyle and prescribing (by clinicians) and adhering (by patients) to evidence-based medications in the management of CHD, not only during the short term but also over the longer term after a cardiac ischemic event. The results may help to increase the proportion of ACS patients who are referred to cardiac rehabilitation centres.
BACKGROUND: Guidelines recommend lifestyle modification and medications to control risk factors in coronary heart disease (CHD). Using data from the observational DYSIS II study, we sought to evaluate the use of guideline-recommended treatments at discharge for acute coronary syndromes (ACS) or in the chronic phase for CHD, and participation in rehabilitation/secondary prevention programs. METHODS AND RESULTS: Between 2013 and 2014, 10,661 patients (3867 with ACS, 6794 with stable CHD) were enrolled in 332 primary and secondary care centers in 18 countries (Asia, Europe, Middle East). Patients with incident ACS were younger and more likely to be smokers than patients with recurrent ACS or stable CHD (both p < 0.0001). Sedentary lifestyle was common (44.4% of ACS patients; 44.2% of stable CHD patients); 22.8% of ACS patients and 24.3% of stable CHD patients were obese. Prevalence of low high-density lipoprotein cholesterol (<40 mg/dL in men/50 mg/dL in women) was 46.9% in chronic CHD and 55.0% in ACS. Rates of secondary prevention medications were lower among CHD versus ACS (all p < 0.0001): antiplatelet 94.3% vs 98.0%, beta-blocker 72.0% vs 80.0%, lipid-lowering therapy 94.7 vs 97.5%, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 69.4% vs 73.7%, respectively. Attendance at cardiac rehabilitation (16.8% of patients with a first ACS, 10.8% with recurrent ACS) or a secondary prevention program (3.7% of ACS and 11.7% of stable CHD patients) was infrequent. CONCLUSIONS: The high prevalence of risk factors in all CHD patients and reduced rates of secondary prevention medications in stable CHD offer areas for improvement. TRANSLATIONAL ASPECTS: The findings of DYSIS II may reinforce the importance of adopting a healthy lifestyle and prescribing (by clinicians) and adhering (by patients) to evidence-based medications in the management of CHD, not only during the short term but also over the longer term after a cardiac ischemic event. The results may help to increase the proportion of ACS patients who are referred to cardiac rehabilitation centres.
Authors: Wolfram Doehner; Mikael Mazighi; Bernd M Hofmann; Dominik Lautsch; Gerhard Hindricks; Erin A Bohula; Robert A Byrne; A John Camm; Barbara Casadei; Valeria Caso; Christophe Cognard; Hans-Christoph Diener; Matthias Endres; Patrick Goldstein; Alison Halliday; Jemma C Hopewell; Dejana R Jovanovic; Adam Kobayashi; Maciej Kostrubiec; Antonin Krajina; Ulf Landmesser; Hugh S Markus; George Ntaios; Francesca R Pezzella; Marc Ribo; Giuseppe Mc Rosano; Marta Rubiera; Mike Sharma; Rhian M Touyz; Petr Widimsky Journal: Eur J Prev Cardiol Date: 2019-09-30 Impact factor: 7.804
Authors: Kornelia Kotseva; John William McEvoy; James Mg Curneen; Conor Judge; Bryan Traynor; Anthony Buckley; Lavanya Saiva; Laura Murphy; Donal Murray; Sean Fleming; Peter Kearney; Ross T Murphy; Godfrey Aleong; Thomas J Kiernan; James O'Neill; David Moore; Bridog Nicaodhabhui; John Birrane; Patricia Hall; James Crowley; Irene Gibson; Catriona S Jennings; David Wood Journal: Open Heart Date: 2021-06