title: Secondary prevention in patients after hospitalisation due to coronary artery disease: what has changed since 2006?
abstract: BACKGROUND
  The evidence concerning the quality of secondary prevention of coronary artery disease (CAD) in Poland in recent years is scarce.
  
  
  OBJECTIVE
  To compare the implementation of secondary prevention guidelines into everyday clinical practice between 2006-2007 and 2011-2012 in patients after hospitalisation due to CAD.
  
  
  METHODS
  Five hospitals with departments of cardiology serving a city and its surrounding districts in the southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalised from April 1, 2005 to July 31, 2006 (first survey) and from April 1, 2010 to June 30, 2011 (second survey) due to acute coronary syndrome or for a myocardial revascularisation procedure were recruited and interviewed 6-18 months after hospitalisation.
  
  
  RESULTS
  Medical records of 640 patients were reviewed and included in the first survey and 466 in the second survey. The proportion of medical records with available information on smoking did not differ between the surveys, whereas the proportion of medical records with available information on blood pressure and total cholesterol was lower in patients hospitalised in 2010-2011. The prescription rate of β-blockers at discharge decreased from 90% to 84% (p < 0.05), whereas the prescription rates at discharge of other drug classes did not change significantly. The proportion of patients with high blood pressure (≥ 140/90 mm Hg) one year after hospitalisation decreased in 2011-2012 compared to 2006-2007 (from 48% to 35%, p < 0.05), whereas the proportion of subjects with high LDL cholesterol, high fasting glucose, and obesity did not change significantly. We did not note a significant difference in the smoking rate. The proportions of patients taking an antiplatelet agent (90% vs. 91%), a β-blocker (87% vs. 79%), an ACE inhibitor or a sartan (79% vs. 76%), a calcium antagonist (22% vs. 25%), a diuretic (35%vs. 45%), and a lipid-lowering drug (86% vs. 87%) one year after discharge did not change significantly (all p > 0.05).
  
  
  CONCLUSIONS
  We noted a modest improvement in the implementation of CAD secondary prevention guidelines in everyday clinical practice: blood pressure was better controlled, although the control of all other main risk factors did not change significantly. Our data provides evidence that there is a considerable potential for further reduction of cardiovascular risk in CAD patients.
authors.affiliation: 1st Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. piotrjankowski@interia.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Jankowski
authors.forename: Danuta
authors.initials: D
authors.lastname: Czarnecka
authors.forename: Radosław
authors.initials: R
authors.lastname: Lysek
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Skrzek
authors.forename: Monika
authors.initials: M
authors.lastname: Smaś-Suska
authors.forename: Adam
authors.initials: A
authors.lastname: Mazurek
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Brzozowska-Kiszka
authors.forename: Renata
authors.initials: R
authors.lastname: Wolfshaut-Wolak
authors.forename: Sławomir
authors.initials: S
authors.lastname: Surowiec
authors.forename: Piotr
authors.initials: P
authors.lastname: Bogacki
authors.forename: Ewa
authors.initials: E
authors.lastname: Bryniarska-Mirek
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.forename: Janusz
authors.initials: J
authors.lastname: Grodecki
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Nessler
authors.forename: Maria
authors.initials: M
authors.lastname: Olszowska
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000517:prevention & control*; D005260:Female; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011044:Poland; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors