Determinants of cardiovascular mortality in a cohort of primary care patients with chronic ischemic heart disease. BARBANZA Ischemic Heart Disease (BARIHD) study.
BACKGROUND
Prognosis of chronic patients with established ischemic heart disease (IHD) is not fully understood. The objective was to determine which factors are related to cardiovascular death and hospitalizations in patients with IHD within a primary care network.


METHODS
A cohort study was carried out by 69 primary care providers in Spain in 2007. Participants were followed up for a mean of 2.2 ± 0.3 years. 1095 patients were recruited if they had established (at least 1 year of known disease) IHD (myocardial infarction or and stable or unstable angina). Several hypothesized determinants of cardiovascular mortality were studied, using Cox proportional hazard regression models. Subgroup analysis was also performed for participants without cardiovascular admissions within the last year.


RESULTS
Mean time since first IHD diagnosis was 7.6 ± 6.0 years. Annual all-cause mortality rate was 3.25%, with 44 cardiovascular deaths and 119 cardiovascular admissions. The main prognostic factor for cardiovascular death was previous heart failure (hazard ratio [HR] 4.32, 95% confidence interval [CI] 2.30 to 8.11, p<0.001). Recent cardiovascular admission doubled the risk for death (HR 2.01, CI 1.06 to 3.81, p=0.031). Results showed that use of beta blockers and increased physical activity were the main protective factors. Patients without a recent cardiovascular admission showed previous heart failure as the main significant factor for cardiovascular death.


CONCLUSIONS
Patients with chronic IHD in a primary care setting may need a closer follow-up in the presence of previous conditions such as heart failure. Physical activity and treatment with beta blockers were the factors giving these patients the greatest protection.
Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. rafavidal@hotmail.com
Rafael
R
Vidal-Perez
Fernando
F
Otero-Raviña
Manuel
M
Franco
José M
JM
Rodríguez Garcia
Rosa
R
Liñares Stolle
Ramona
R
Esteban Alvarez
Cristina
C
Iglesias Díaz
Elena
E
Outeiriño López
María José
MJ
Vázquez López
José Ramón
JR
Gonzalez-Juanatey
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011320:Primary Health Care / Q000639:trends*; D013030:Spain / Q000453:epidemiology