Fast track — ArticlesClinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries
Introduction
The objective for patients with coronary heart disease (CHD) is to reduce their risk of further coronary and other atherosclerotic events, to improve quality of life, and to increase the chances of survival. Such patients are defined as the highest priority for prevention in the recommendations drawn up by the European Society of Cardiology, the European Atherosclerosis Society, and the European Society of Hypertension (collectively known as the Joint European Societies).1, 2 The aim of these recommendations is to raise the standard of preventive cardiology by stimulating the development and revision of national guidelines by multidisciplinary alliances of professional societies, and their dissemination, implementation, and audit by cardiologists and other physicians in hospitals and the community. The European recommendations define goals with regard to lifestyle, risk factors, and therapy. These goals are to stop smoking, make healthy food choices, and become physically active; to achieve a body-mass index (BMI) of less than 25 kg/m2, a blood pressure of lower than 140/90 mm Hg, a total cholesterol concentration of less than 5·0 mmol/L, and an LDL-cholesterol concentration of less than 3·0 mmol/L; and to use appropriate prophylactic drugs such as aspirin or other platelet-modifying drugs, β-blockers, angiotensin-converting-enzyme (ACE) inhibitors, and anticoagulants.
After the publication of the Joint European Societies' recommendations on coronary prevention in 1994, the European Society of Cardiology did a survey called EUROASPIRE I (European Action on Secondary Prevention by Intervention to Reduce Events) in nine countries: the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, Slovenia, and Spain during 1995–96.3 This study focused on patients with CHD, and was based on a survey in the UK called ASPIRE.4 Both surveys showed a high prevalence of modifiable risk factors, and therefore substantial potential to reduce the risk of recurrent non-fatal coronary disease and death. After the publication of the 1998 Joint European Societies' recommendations on coronary prevention, another survey (EUROASPIRE II) was done in 15 European countries under the auspices of the European Society of Cardiology, Euro Heart Survey Programme, including the same countries, and almost identical centres, that participated in the first survey. The main results of EUROASPIRE II have now been published.5 One of the objectives of this second survey was to see whether the practice of preventive cardiology in patients with CHD has improved in the centres that took part in EUROASPIRE I. Here we fulfil this objective by comparing the results of EUROASPIRE I and EUROASPIRE II.
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Sample size and data collection
Each survey was undertaken in 21 centres, 20 of which were common to both studies. One of the Italian centres from EUROASPIRE I did not participate in EUROASPIRE II, and one new hospital was added in France in the second survey.
Within each hospital, we identified consecutive patients (men and women ≤ 70 years of age at the time of index event or procedure) with the following diagnoses: first elective or emergency coronary-artery bypass graft (CABG); first elective or emergency percutaneous
Results
4863 hospital medical records were reviewed in EUROASPIRE I, and 4914 in EUROASPIRE II; 3569 and 3379 patients were interviewed, respectively. In this paper, comparisons are based only on the data obtained at interview.
Table 1 shows the number of patients interviewed and participation rate by country, diagnostic category, sex, and age. The total participation rate of those who were contacted and found alive was 77·9% for EUROASPIRE I and 77·8% for EUROASPIRE II. In the first survey, the
Discussion
The results of this comparison of the findings from two European surveys during 1995–96 and 1999–2000 will be concerning for all involved in the care of patients with CHD. Adverse lifestyle trends, especially the substantial increase in obesity in every country, and of smoking among younger patients, are probably a consequence of wider social changes. However, physicians must also accept some responsibility for them, because most patients with CHD did not participate in any form of professional
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