scholarly journals Survey of risk factors in coronary heart disease (SURF CHD) II: rationale, methods for a novel recruitment strategy and preliminary results

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Marza Florensa ◽  
I Vaartjes ◽  
K Klipstein-Grobusch ◽  
M Zhao ◽  
MT Cooney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
East Asia ◽  
Clinical Audit ◽  
Recruitment Strategy ◽  
South East Asia ◽  
Preventive Cardiology ◽  
Preliminary Results

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): European Association of Preventive Cardiology Introduction SURF CHD (Survey of Risk Factors in Coronary Heart Disease) is a clinical audit on risk factors and secondary prevention among CHD patients. The first wave of the study showed usefulness of the tool and poor control of risk factors, however the centres were identified by personal contacts. A more formal recruitment strategy was required to increase representativeness in the second wave of the study (SURF CHD II). Purpose: SURF CHD II aims to simplify recording and assessment of risk factor management and medication in CHD patients, while using a novel recruitment strategy that improves representativeness of results and provides a wider picture of secondary prevention of CHD. Methods: The survey is conducted electronically during routine outpatient visits. Data on demographics, risk factors, laboratory and physical measurements and medications is collected and summarized. The novel recruitment strategy is based on the pre-existing network of a renowned association of preventive cardiology, which designates a National Cardiovascular disease Prevention Coordinator (NCPC) for several countries. NCPCs were invited to participate in the clinical audit; selected national cardiac societies were invited to pilot recruitment in countries without a designated NCPC; and clinicians that independently showed interest in SURF were welcome to participate too. The SURF team and interested country representatives held meetings to discuss a tailor-made approach for the implementation of the audit in each country. Results: A total of 48 NCPCs, 11 national cardiac societies and 9 individual contacts were invited to SURF. In 18 meetings with country representatives, enrolment of centres adapting to the countries’ characteristics were discussed. To date, 95 centres in 31 countries have agreed to participate and have enrolled 6145 participants: 88 in Eastern Mediterranean, 4786 in Europe, 108 in the Americas, 1069 in South East Asia and 13 in Western Pacific. 80.11% of the centres are public and 96.73% are located in urban areas. 25.21% of participants were female and mean age was 63.82 ± 18 years. 75.99% of the study population were overweight or obese and 16.6% were smokers. Blood pressure lower than <140/90mmHg was reported in 61.05% of participants, 20.58% had LDL <1.8 mmol/l and 39.58% had  HbA1c < 7%. 27.15% of participants attended cardiac rehabilitation. South East Asia recorded the lowest prevalence of overweight and obesity and LDL levels. Lowest use of statins was recorded in Europe (78.94%), and of angiotensin-converting enzyme inhibitors in the Americas (14.18%). Conclusions: The recruitment strategy based on the preventive cardiology association’s network is successful. Preliminary results indicate regional variations in risk factors and secondary prevention. SURF will continue to collaborate with NCPCs national cardiac societies to promote the survey and achieve a broader insight on secondary prevention of CHD with a simplified tool.

scholarly journals Investigation of the Adherence to Prescribed Treatment of the Patients with Coronary Heart Disease

2021 ◽  
Vol 6 (5) ◽  
pp. 263-269
Author(s):  
V. O. Shuper ◽  
◽  
S. V. Shuper ◽  
I. V. Trefanenko ◽  
G. I. Shumko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Cardiovascular Mortality ◽  
Healthcare Professionals ◽  
Complete Information ◽  
Cardiovascular Death ◽  
Medical Risk ◽  
Medical Risk Factors

The purpose of the study was to investigate the adherence to secondary prevention medications among patients with coronary heart disease and identify factors associated with it. Materials and methods. We examined 40 patients diagnosed with coronary heart disease of more than 50 years old, who were prescribed with optimal medication for 1 year during hospitalization. Patients` adherence was defined according to MMS-8 Morisky values for secondary prevention medications prescribed by doctors. Also, questionnaires about individual reasons of non-compliance and for individual patient`s opinion about importance and usefulness of knowledge according to risk factors of the increase of cardiovascular mortality were designed and proposed to the patients. Simple descriptive statistics were used to elucidate the characteristics of the patient population and results from individual adherence tools. Final score was analyzed and correlation between patients’ data and level of adherence to prescribed treatment were identified. A correlation matrix (using Spearman’s coefficient) was reviewed for any evidence of collinearity. Results and discussion. Our study demonstrated higher level of non-adherence with secondary prevention medications in patients with coronary heart disease (60.0%). This fact can be explained by the socioeconomic reasons, less informative strategies from the medical staff to the patients. Severe regress of adherence was demonstrated after discharge from the hospital due to subjective improvement of the patients` condition with absence of supervision by out-patient specialists. Demographic characteristics of the patients suggested that some non-modified factors can affect compliance with the prescribed treatment. Better adherence was demonstrated by female married patients with higher educational level, with family history about cardiovascular death. Also, too much prescribed medications with difficult regime of usage with non-adequate out-patient supervision may significantly decrease adherence causing development of complications which may lead to re-hospitalizations and cardiovascular death. Our investigation demonstrated also non-complete information of the patients about lifestyle and medical risk factors of the cardiovascular mortality increase. Conclusion. The results of our study can provide useful practical information on the prevalence and severity of non-adherence among patients with coronary heart disease. Analysis of the factors influencing the adherence demonstrated the main reasons from patients and healthcare professionals affecting the level of compliance with the prescribed treatment. The step towards improving adherence can be initiated by the healthcare professional to overcome the patient's concerns about the prescribed medication. It is important to continue personal monitoring of patients by healthcare professionals in the form of regular inspections of intentional and unintentional non-adherence, including factors and reasons that may change and lead to such behavior

To Examine the Effectiveness of a Hospital-Based Nurse-Led Secondary Prevention Clinic

2005 ◽  
Vol 4 (4) ◽  
pp. 308-313 ◽  
Author(s):  
Paula M. Mainie ◽  
Gillian Moore ◽  
John W. Riddell ◽  
A.A. Jennifer Adgey
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Cardiac Event ◽  
Artery Bypass ◽  
Effective Means ◽  
Pilot Project ◽  
Lifestyle Changes ◽  
Prevention Clinic

Modification of cardiovascular risk factors can reduce the incidence of myocardial infarction (MI), effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with known cardiovascular disease. Pharmacological treatments and important lifestyle changes reduce people's risks substantially (by 1/3 to 2/3) and can slow and perhaps reverse progression of established coronary disease. When used appropriately, these interventions are more cost-effective than many other treatments, currently provided by the National Health Service [Department of Health National Service Frameworks: coronary heart disease. Preventing coronary heart disease in high risk patients. 2000. HMSO.] Secondary prevention clinics are effective means by which to ensure targets are achieved and assist primary care in long-term maintenance of lifestyle change and drug optimisation. A 2-year hospital-based pilot project was established at the Royal Hospitals, April 2001–April 2003. The aim of the project was to target patients with coronary heart disease, post-MI and/or coronary artery bypass grafting and/or percutaneous coronary intervention, 6 months following their cardiac event. The plan was to assess patient risk factors and medication a minimum of 6 months following their cardiac event to ascertain if government targets were being achieved; secondly, to examine the effectiveness of a hospital-based nurse-led secondary prevention clinic on modifying risk factors and optimising drug therapies.

scholarly journals Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Christoph Herrmann-Lingen ◽  
Christian Albus ◽  
Martina de Zwaan ◽  
Franziska Geiser ◽  
Katrin Heinemann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Collaborative Care ◽  
Primary Outcome ◽  
Cardiac Risk Factor ◽  
Randomized Controlled ◽  
Chd Risk Factors

Abstract Background Coronary heart disease (CHD) is the leading cause of death and years of life lost worldwide. While effective treatments are available for both acute and chronic disease stages there are unmet needs for effective interventions to support patients in health behaviors required for secondary prevention. Psychosocial distress is a common comorbidity in patients with CHD and associated with substantially reduced health-related quality of life (HRQoL), poor health behavior, and low treatment adherence. Methods In a confirmatory, randomized, controlled, two-arm parallel group, multicenter behavioral intervention trial we will randomize 440 distressed CHD patients with at least one insufficiently controlled cardiac risk factor to either their physicians' usual care (UC) or UC plus 12-months of blended collaborative care (TeamCare = TC). Trained nurse care managers (NCM) will proactively support patients to identify individual sources of distress and risk behaviors, establish a stepwise treatment plan to improve self-help and healthy behavior, and actively monitor adherence and progress. Additional e-health resources are available to patients and their families. Intervention fidelity is ensured by a treatment manual, an electronic patient registry, and a specialist team regularly supervising NCM via videoconferences and recommending protocol and guideline-compliant treatment adjustments as indicated. Recommendations will be shared with patients and their physicians who remain in charge of patients’ care. Since HRQoL is a recommended outcome by both, several guidelines and patient preference we chose a ≥ 50% improvement over baseline on the HeartQoL questionnaire at 12 months as primary outcome. Our primary hypothesis is that significantly more patients receiving TC will meet the primary outcome criterion compared to the UC group. Secondary hypotheses will evaluate improvements in risk factors, psychosocial variables, health care utilization, and durability of intervention effects over 18–30 months of follow-up. Discussion TEACH is the first study of a blended collaborative care intervention simultaneously addressing distress and medical CHD risk factors conducted in cardiac patients in a European health care setting. If proven effective, its results can improve long-term chronic care of this vulnerable patient group and may be adapted for patients with other chronic conditions. Trial registration: German Clinical Trials Register, DRKS00020824, registered on 4 June, 2020; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020824

The treatment of hyperlipidaemia in postmenopausal women

2001 ◽  
Vol 7 (1) ◽  
pp. 28-32
Author(s):  
Mary Seed ◽  
R Mandeno ◽  
C Le Roux
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Ldl Cholesterol ◽  
Factor Vii ◽  
Current Evidence

This review summarises current evidence for therapeutic options for hyperlipidaemia in post menopausal women. The two situations in which treatment is recommended are: 1. Primary prevention, which requires assessment of total risk factors for coronary heart disease. a) Statins. AFCAPS/TEXCAPS is the only randomised controlled trial (RCT) to include women. Fewer coronary heart disease (CHD) events, but no difference in mortality was found. b) Hormone replacement therapy (HRT). While there are numerous reports of positive observational epidemiological studies for HRT, there are no completed RCTs. There is little evidence for statin use in women except for familial hypercholesterolaemia. HRT is therefore not only appropriate for its multiple effects on lipoproteins, vascular function and insulin sensitivity but also for prevention of osteoporosis. 2. Secondary prevention, to achieve target total and low density lipoprotein (LDL) cholesterol. a) Statins. The major measurable effect of these drugs is to reduce total and LDL cholesterol. In the RCTs 4S, CARE and LIPID, where 20% of subjects were female, CHD events, but neither CHD mortality nor total mortality were significantly reduced in women. b) HRT. Data available from two RCTs using conjugated equine oestrogens and medroxyprogesterone acetate show no benefit. Other studies of HRT have been observational and positive. The effects of treatment on lipoproteins with statins, HRT and the combination have been investigated. In secondary prevention for hyperlipidaemic women to achieve cholesterol <5 and LDL<3 mmol/L statins will be first choice, with HRT a possible addition for its other benefits on cardiovascular risk factors. Choice of HRT medication. The route of administration will affect specific risk factors, eg, oral oestrogen reduces Lp(a) and LDL, increases HDL, while the transdermal route is less effective at reducing Lp(a) and LDL but does not increase triglyceride. Both routes reduce fibrinogen, factor VII and adhesion molecules and improve blood flow. The choice of progestogen will also affect cardiovascular risk factors. The most important lipid risk factors in women are HDL, triglyceride and Lp(a). The risk associated with raised triglyceride and LDL is offset by high HDL. Thus, in women with risk factors in primary prevention, theoretically oral HRT with a non-androgenic progestogen is likely to be of most benefit. However, since long-term adherence to therapy is important in reducing cardiovascular risk, the individual's choice of route and type of HRT is paramount.

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