The Swedish National Programme for Quality Control of Secondary Prevention of Coronary Artery Disease--results after one year.
BACKGROUND
Guidelines for the prevention of coronary artery disease (CAD) have been developed both in Europe and in the USA. However, several surveys have shown that these guidelines are poorly implemented in clinical practice.


METHODS
The Swedish Quality Control Programme on Secondary Prevention of CAD includes patients after myocardial infarction, or having undergone coronary artery surgery or percutaneous coronary intervention. Fifty of Sweden's 79 hospital districts are currently participating. Patients are asked to send report-cards regarding risk factor management to a central registry after discharge from hospital, at a 3-6 month visit and then yearly for 5 years.


RESULTS
Results based on data from 1 year after the index event show that a majority of patients reach targets for serum cholesterol (70%), and low-density lipoprotein (LDL)-cholesterol (71%). Mean value for total cholesterol is 4.6 (+/-SD 0.9) mmol/l, LDL-cholesterol 2.7 (+/-SD 0.8) mmol/l. Blood pressure targets are less often achieved, with 58% reaching the European Society of Cardiology target for systolic (<140 mmHg) and 81% for diastolic (<90 mmHg) blood pressure. A large proportion of patients are prescribed preventive drugs: aspirin (96%), beta-blockers (78%) and lipid-lowering drugs (83%).


CONCLUSIONS
The Swedish Quality Control Programme is one of the first attempts to assess implementation of guidelines on a national level based on patient participation. It is hoped that shared care programmes and increased patient involvement with feedback on achieved treatment goals in relation to guidelines will improve outcomes in patients with CAD.
Stagmo
Martin
M
Department of Cardiology, University Hospital, Malmö; Gråbo Health Centre, Visby, Sweden. martin.stagmo@skane.se
Israelsson
Bo
B
Brandström
Hans
H
Hedbäck
Bo
B
Lingfors
Hans
H
Nilsson
Peter
P
Erhardt
Leif
L
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002309:Cardiology / Q000592:standards; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D017598:Efficiency, Organizational; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010351:Patient Discharge; D011314:Preventive Health Services / Q000592:standards; D015397:Program Evaluation / Q000592:standards; D011786:Quality Control; D015203:Reproducibility of Results; D012307:Risk Factors; D012308:Risk Management / Q000592:standards; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D013599:Systole / Q000187:drug effects / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL