Secondary prevention of coronary artery disease in hospital practice over the decade 1996-2006. Results of the Cracovian Program for Secondary Prevention of Ischaemic Heart Disease and Polish parts of the EUROASPIRE II and EUROASPIRE III surveys.
BACKGROUND
Both in the European and Polish guidelines the highest priority for preventive cardiology was given to patients with established cardiovascular disease. The Cracovian Program for Secondary Prevention of Ischaemic Heart Disease was initiated in 1996. The main goal of the program was to assess and improve the quality of clinical care in the secondary prevention of ischaemic heart disease. Later, the same centres joined the EUROASPIRE (European Action on Secondary and Primary Prevention Intervention to Reduce Events) II and III surveys.


OBJECTIVE
To compare the quality of secondary prevention in Krakow cardiac departments in 1996/1997, 1998/1999 and 2005/2006.


METHODS
Five hospitals serving the area of the city of Krakow and surrounding districts (former Krakow Voivodship), inhabited by 1,200,000 persons, took part in the surveys. Consecutive patients hospitalised from July 1, 1996 to September 31, 1997 (first survey), from March 1, 1998 to March 30, 1999 (second survey), and from April 1, 2005 to July 31, 2006 (third survey) due to acute myocardial infarction, unstable angina or for myocardial revascularisation procedures, below the age of <71 years were recruited and included to the present analysis. All medical records were reviewed by trained reviewers using standardised data collection forms.


RESULTS
Medical records of 536 patients treated in 1996/1997, 515 treated 1998/1999, and 540 treated in 2005/2006 were reviewed and analysed. Proportions of medical records with available information on risk factors prior to hospitalisation as well as proportions of medical records with available information on blood pressure (by 10%, p < 0.05) and lipids (by over 30%, p < 0.05) measurements during the first 24 h of hospitalisation as well as on weight and height measurements (by 16%, p < 0.05) increased significantly from 1996/1997 to 2005/2006. Antiplatelets prescription rate at discharge increased from 87% to 97% (p < 0.05), prescription rate for beta-blockers increased from 66% to 91% (p < 0.05), ACE inhibitors/sartans from 50% to 89% (p < 0.05), and lipid lowering drugs from 27% to 96% (p < 0.05) between 1996/1997 and 2005/2006, respectively.


CONCLUSIONS
The implementation of secondary prevention guidelines into clinical practice in the Krakow cardiac departments improved in 2005/2006 as compared to 1996/1997 and 1998/1999. Our results suggest that recent decade brought significant improvement in the approach to secondary prevention of ischaemic heart disease in hospital practice.
Jankowski
Piotr
P
1st Department of Cardiology and Hypertension, Jagiellonian University Collegium Medicum, Krakow, Poland. piotrjankowski@interia.pl
Kawecka-Jaszcz
Kalina
K
Pajak
Andrzej
A
Surowiec
Stawomir
S
Wolfshaut
Renata
R
Loster
Magdalena
M
Badacz
Leszek
L
Dubiel
Jacek S
JS
Grodecki
Janusz
J
Grodzicki
Tomasz
T
Maciejewicz
Janusz
J
Mirek-Bryniarska
Ewa
E
Piotrowski
Wiesław
W
Smielak-Korombel
Wanda
W
Tracz
Wiesława
W
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000517:prevention & control* / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000379:methods*; D011044:Poland / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000458:organization & administration*; D015397:Program Evaluation; D055502:Secondary Prevention
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors