[Health care quality: medication and prevention in patients with and without coronary heart disease].
OBJECTIVE
Next to noninvasive-recently also invasive-diagnostics, ambulant care in patients with coronary heart disease (CHD) should focus on optimal medication and prevention. The aim of this study was to evaluate actual health care quality concerning drug prescription and preventive care in patients with CHD.


METHODS
This prospective study was conducted from March 1999 to February 2002 at the University Hospital Bergmannsheil, Bochum, Germany. 300 patients admitted with a suspected CHD and without previous coronary angiography or myocardial infarction were enrolled. Diagnostic and therapeutic regimen complied with actual guidelines. 248 patients (82.7%) including 116 patients with angiographically confirmed CHD were examined after 1 year.


RESULTS
On follow-up, only 70.9% of patients with confirmed CHD received a beta-blocker, 83.6% were treated with platelet aggregation inhibitors. Body mass index, portion of overweight patients, and HbA(1c) in patients with diabetes did not change during observation. After 1 year, 48.0% of the subjects had a systolic blood pressure > 139 mmHg, in 22.6% diastolic pressure level was > 89 mmHg. Blood level of low-density cholesterol exceeded the recommended range in 57.0% of the cases observed with equally high portion of inadequately treated patients in the group with confirmed CHD and in the group without CHD.


CONCLUSIONS
Drug therapy, primary and secondary prevention in the observed subjects were fairly poor. Remarkable deficits in health care quality became obvious. There is no lack in availability of evaluated, effective and efficient measures. Thus, physicians' efforts to implement evidence-based guidelines into clinical practice have to be strengthened.
Baberg
Henning Thomas
HT
Medizinische Klinik II, Kardiologie und Angiologie, BG-Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum, Bochum, Germany. henning.baberg@rub.de
Yazar
Aydan
A
Brechmann
Thorsten
T
Grewe
Peter
P
Kugler
Joachim
J
De Zeeuw
Justus
J
Bojara
Waldemar
W
Lawo
Thomas
T
Mügge
Andreas
A
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D003627:Data Interpretation, Statistical; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors