Implementation of cardiovascular secondary prevention guidelines in clinical practice: a nationwide survey in Italy.
OBJECTIVE
To report the implementation of cardiovascular secondary prevention guidelines following a cardiovascular event in Italy.


RESULTS
Data were collected from 878 consecutive patients, who had suffered a cardiovascular event requiring hospitalisation in the preceding 12-24 months and who presented at 49 outpatient clinics across Italy. Cardiovascular risk markers were assessed through clinical examination, interview and reviewing of patients' charts; in addition, we collected information on changes in prevalence of selected risk factors that occurred since the time of index event. At the time of evaluation, increased body mass index (BMI) was observed in 35% of patients, with 20% being obese; 26% had diabetes and 21% uncontrolled hypertension. Although 91% of patients were on statins, no measurement of low-density lipoprotein (LDL)-cholesterol was available in the previous 6 months in 27% of patients and 16% had no knowledge of any lipid parameter in the same period. In the remaining patients, LDL was <100 mg dl(-1) in 57% and <70 mg dl(-1) in 20% of them. From the time of index event to interview, prevalence of uncontrolled hypertension remained stable, from 24% to 21% of patients; according to the patients' self-reporting, smoking had declined from 32% to 13% of patients and physical inactivity from 43% to 33% of patients.


CONCLUSIONS
This survey shows, in a large national cohort, a suboptimal implementation of lifestyle changes and inadequate lipid control in patients at high cardiovascular risk after a cardiovascular event. Reinforcement of patients and physicians, implementation and adherence to guidelines is needed to reduce the burden of cardiovascular disease.
Perrone-Filardi
P
P
Department of Internal Medicine, Cardiovascular Sciences and Immunology, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy. fpperron@unina.it
Poli
A
A
Ambrosio
G
G
Proto
C
C
Chimini
C
C
Chiariello
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007407:Interviews as Topic; D007558:Italy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000379:methods; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors