Cardiovascular prevention in coronary heart disease patients: guidelines implementation in clinical practice.
OBJECTIVE
To demonstrate the utilization of a clinical improvement program in stable coronary artery disease patients to increase the evidence-proven treatment utilization, and to describe the ongoing clinical practice and lifestyle change counseling.


METHODS
Cross-sectional study followed by a longitudinal component in which the tools utilization to improve clinical practice was assessed by means of additional cross-sectional data collection. 710 consecutive patients were included (Phase 1). After tools implementation, within 6 months period, 705 patients were included (Phase 2) for comparative analysis. Randomly, 318 patients from Phase 1 were selected, 6-12 months after the first evaluation (Phase 3).


RESULTS
Phase 1 to Phase 2: there were improvement on smoking cessation (P=0.019), dyslipidemia (P<0.001), hypertension and physical activity (P<0.001). There was significant difference on angiotensin converting enzyme inhibitors - ACEI (67.2% vs. 56.8%, P<0.001); angiotensin II receptor blockers - ARB II (25.4% vs. 32.9%, P=0.002) and beta-blocker (88.7% vs. 91.9%, P=0.047). Phase 1 to Phase 3: there was both weight (P=0.044), and blood pressure reduction (P<0.001). There was statistical significant difference on ACEI (64.8% vs. 61.6%, P=0.011) and ARB II (27.0% vs. 31.3%, P=0.035).


CONCLUSIONS
There was no significant change on the evidence-based pharmacological treatment utilization between pre and post-intervention phases; there was significant improvement concerning smoking and physical activity in phase 2; substantial improvement on blood pressure levels in both comparisons (Phase 1 to 2 and Phase 1 to 3). The inclusion of a case-manager for the process management was crucial for program efficacy. Comprehensive programs for clinical practice should be pursued for longer follow-up period.
Medical Unit of Coronary Diseases at Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil. brasilcki@uol.com.br
Clarisse Kaoru Ogawa
CK
Indio do Brasil
Alvaro
A
Avezum
Luciana
L
Uint
Maria Isabel
MI
Del Monaco
Valéria Mozetic de
VM
Barros
Soraia Youssef Rachid
SY
Campos
Amanda M R
AM
Sousa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016540:Smoking Cessation; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents