Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease.
Arch Cardiovasc Dis
; 108(6-7): 340-6, 2015.
Article
in En
| MEDLINE
| ID: mdl-25858539
ABSTRACT
BACKGROUND:
In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome.AIMS:
To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD.METHODS:
We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing.RESULTS:
The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042).CONCLUSIONS:
Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Angiotensin-Converting Enzyme Inhibitors
/
Adrenergic beta-Antagonists
/
Coronary Disease
/
Angiotensin II Type 1 Receptor Blockers
/
Fibrinolytic Agents
/
Myocardial Infarction
Type of study:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Prevalence_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Arch Cardiovasc Dis
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2015
Document type:
Article
Affiliation country:
France