What can we learn from Europe?

K Swedberg

Correspondence to:
Correspondence to:
Professor Karl Swedberg
Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden; karl.swedberg{at}hjl.gu.se

The European Society of Cardiology has produced guidelines for the treatment of acute myocardial infarction as well as for chronic heart failure and for the use of ß blockers and angiotensin converting enzyme inhibitors. These documents provide clear evidence and strength of recommendations for the secondary prevention of complications after a myocardial infarction. The identification of heart failure and left ventricular systolic dysfunction are important risk factors in this context. The use of secondary prevention treatments in Europe has been evaluated in several surveys. The use of treatments varies across the participating countries and evidence based therapies in general are under-utilised. Various approaches have been taken to disseminate evidence based secondary prevention. Experience from the Italian BRING-UP collaboration illustrates how the use of ß blockers can be increased. Similarly, the Swedish RIKS-HIA registry of acute myocardial infarction has increased the use of secondary preventive treatments.

Abbreviations: ACE, angiotensin converting enzyme; ARB, angiotensin II receptor blocker; BRING-UP, ß blockers in patients with congestive heart failure: guide use in clinical practice; CCU, coronary care unit; COMPANION, comparison of medical therapy, pacing and defibrillation in heart failure; CRT, cardiac resynchronisation therapy; DINAMIT, defibrillator in acute myocardial infarction trial; EPHESUS, eplerenone neurohormonal efficacy and survival study; ESC, European Society of Cardiology; GRACE, global registry of acute coronary events; ICD, implantable cardioverter-defibrillator; MADIT II, multicenter automatic defibrillator implantation trial II; MI, myocardial infarction; NYHA, New York Heart Association; RALES, randomized aldactone evaluation study; RIKS-HIA, Register of Information and Knowledge about Swedish Heart Intensive care Admissions; TRACE, trandolapril cardiac evaluation; VALIANT, valsartan in acute myocardial infarction trial

Keywords: angiotensin converting enzyme inhibitors; angiotensin receptor blockers; myocardial infarction; ß blockers; eplerenone; heart failure

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