The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina.
OBJECTIVE
The European Society of Cardiology published guidelines for the management of stable angina in 1997, with the objective of promoting an evidence-based approach to the condition. This study focuses on the impact of guideline compliant medical treatment on clinical outcome in patients with stable angina.


RESULTS
The Euro Heart Survey of Stable Angina is a multicentre prospective observational study conducted between 2002 and 2003. Patients with a clinical diagnosis of stable angina by a cardiologist were enrolled and follow-up was conducted at 1 year. The primary outcome of interest was death or myocardial infarction (MI). The increasing intensity of guideline compliant medical therapy was quantified by means of a simple treatment score based on the use of guideline advocated therapies: antiplatelets, statins, and beta-blockers. A total of 3779 patients were included in the initial survey. Increasing intensity of guideline compliant therapy at initial assessment was associated with a reduction in death and MI during follow-up in patients with angina and confirmed coronary disease (HR 0.68; 95% CI 0.49-0.95 per unit increase in treatment score). All cardiovascular events were also significantly reduced in this subgroup (HR 0.82; 95% CI 0.69-0.97). The benefits of guideline compliant therapy were only observed in patients with objective evidence of coronary disease.


CONCLUSIONS
Guideline compliant medical therapy improves clinical outcome in patients with stable angina and objective evidence of coronary disease.
Daly
Caroline
C
Royal Brompton and Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, and London School of Hygiene and Tropical Medicine, SW3 6NP, UK. caroline.daly@imperial.ac.uk
Clemens
Felicity
F
Lopez-Sendon
Jose L
JL
Tavazzi
Luigi
L
Boersma
Eric
E
Danchin
Nicholas
N
Delahaye
Francois
F
Gitt
Anselm
A
Julian
Desmond
D
Mulcahy
David
D
Ruzyllo
Witold
W
Thygesen
Kristian
K
Verheugt
Freek
F
Fox
Kim M
KM
D000704:Analysis of Variance; D000787:Angina Pectoris / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors