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Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III

Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III. Professor David A Wood on behalf of the EUROASPIRE Investigators. EUROASPIRE I, II and III. Finland. Netherlands. Germany. Slovenia. Czech Republic. France. Italy. Hungary.

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Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III

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  1. Risk factor management in coronary patients – results from a European wide survey EUROASPIRE III • Professor David A Wood • on behalf of the EUROASPIRE Investigators

  2. EUROASPIRE I, II and III Finland Netherlands Germany Slovenia Czech Republic France Italy Hungary

  3. Participation rates Survey I : 77.2% Survey II : 76.5% Survey III : 68.4%

  4. Distribution of Age, Gender and Diagnostic Category Gender Age Diagnostic category (%) (years) (%) (%) (%) (%) (%)

  5. Prevalence of Smoking* * Self-reported smoking or CO in breath > 10 ppm S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.37 S3 vs. S1 : P=0.48 P=0.64

  6. Prevalence of Overweight* * Body mass index ≥ 25 kg/m² S2 vs. S1 : P=0.15 S3 vs. S2 : P=0.22 S3 vs. S1 : P=0.02 P=0.04

  7. Prevalence of Obesity* * Body mass index ≥ 30 kg/m² S2 vs. S1 : P=0.009 S3 vs. S2 : P=0.051 S3 vs. S1 : P=0.0002 P=0.0006

  8. Prevalence of Central Obesity* * Waist circumference ≥ 102 cm in men or ≥ 88 cm in women S2 vs. S1 : P=0.0001 S3 vs. S2 : P=0.47 S3 vs. S1 : P<0.0001 P<0.0001

  9. Prevalence of Raised Blood Pressure (1)* * SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.51 S3 vs. S1 : P=0.65 P=0.79

  10. Prevalence of Raised Blood Pressure (2)* * SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg diabetics S2 vs. S1 : P=0.99 S3 vs. S2 : P=0.30 S3 vs. S1 : P=0.30 P=0.49

  11. Therapeutic Control of Blood Pressure* * SBP/DBP < 140/90 mmHg for non-diabetics or < 130/80 mmHg for diabetics S2 vs. S1 : P=0.98 S3 vs. S2 : P=0.36 S3 vs. S1 : P=0.37 P=0.57

  12. Prevalence of Raised Total Cholesterol* * Total cholesterol ≥ 4.5 mmol/L P<0.0001 S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001

  13. Prevalence of Raised LDL Cholesterol* • LDL C ≥ 2.5 mmol/L for patients fasting for at least 6 hours P<0.0001 S2 vs. S1 : P=0.001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001

  14. Therapeutic Control of Total Cholesterol* * Total cholesterol < 4.5 mmol/L S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

  15. Prevalence of Diabetes* * Self-reported history of diagnosed diabetes S2 vs. S1 : P=0.21 S3 vs. S2 : P=0.02 S3 vs. S1 : P=0.001 P=0.004

  16. Prevalence of Undiagnosed Diabetes* * Glucose ≥ 7 mmol/L for patients fasting for at least 6 hours S2 vs. S1 : P=0.002 S3 vs. S2 : P=0.62 S3 vs. S1 : P=0.006 P=0.005

  17. Therapeutic Control of Diabetes* * Fasting glucose < 7 mmol/L in patients with history of diabetes S2 vs. S1 : P=0.82 S3 vs. S2 : P=0.03 S3 vs. S1 : P=0.08 P=0.04

  18. Medication Use: Antiplatelets S2 vs. S1 : P=0.29 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

  19. Medication Use: Beta-Blockers S2 vs. S1 : P=0.001 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

  20. Medication Use: ACE Inhibitors & Angiotensin II RA S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

  21. Medication Use: Statins S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

  22. Medication Use: Diuretics S2 vs. S1 : P=0.30 S3 vs. S2 : P=0.02 S3 vs. S1 : P=0.002 P=0.006

  23. Lifestyle of coronary patients is a major cause for concern with no change in prevalence of smoking and continuing adverse trends in prevalence of obesity and central obesity Conclusions from the EUROASPIRE surveys

  24. No change in blood pressure control despite increased use of anti-hypertensive medications 61% above therapeutic target (BP < 140/90 mmHg) Continuing improvement in lipid control with increased use of statins 42% above the 2003 therapeutic target (TC < 4.5 mmol/l) Conclusions

  25. Increasing prevalence of diabetes, both self reported and undetected, and deteriorating therapeutic control 78% above the therapeutic target of < 7.0 mmol/l Increased use of anti-platelets, beta- blockers, ACE/ARB’s, statins and diuretics with a lower use of CCB’s. Conclusions

  26. ‘A handful of pills is not enough’ Conclusions

  27. Standards and Core Components for Cardiac Rehabilitation 2007 Lifestyle Education Risk factor management Psychosocial Cardio-protective drug therapy Long term management strategy Cardiac Rehabilitation

  28. Standards and Core Components for Cardiac Rehabilitation 2007 Core team Cardiac specialist nurse Physiotherapist Dietician Administrator Designated clinical lead Cardiac Rehabilitation

  29. Advise to follow cardiac rehabilitation programme* EuroASPIRE III Interview All patients: 44.9% MOR = 5.46 Men 45.9% , Women 42.0% * Within 3 months of discharge following the index event or procedure

  30. Attendance at CR programme among all patients* EuroASPIRE III Interview All patients: 33.9% MOR = 7.07 Men 34.9% , Women 31.0% * Attending at least half of the sessions Note: CPR attendance rate if advised to follow = 75.8%

  31. EUROACTION 8 countries, 24 centres, 10,000+ subjects

  32. Nurse coordinated multidisciplinary family based approach The CVP&R team with Dr Martini in Boldrini Hospital, Thiene, Italy The CVP nurse with Dr Van Nunen in Hoensbroek, The Netherlands

  33. EUROACTION and EUROASPIRE III * WC < 94 cm (men); < 84 cm (women) **SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetics ****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with diabetes

  34. EUROACTION and EUROASPIRE III * WC < 94 cm (men); < 84 cm (women) **SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetics ****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with diabetes

  35. EUROACTION and EUROASPIRE III

  36. Conclusions • Annie Holden • annie.holden@bromleymytime.org.uk • Jennifer Jones • j.jones@imperial.ac.uk

  37. Professor Ulrich Keil (Chairman) Professor Philippe Amouyel Professor Guy de Backer Professor Dirk De Bacquer Professor Alain Cohen-Solal Professor Dan Gaita Ms Catriona Jennings Dr Kornelia Kotseva Ms Malika Manini Dr Keith McGregor Professor Andrzej Pajak Professor Zeljko Reiner Professor David Wood (Principal Investigator) Management Committee

  38. Coordinating Centre Department of Cardiovascular Medicine Imperial College London UK Data Management Euro Heart Survey Team Sophia Antipolis, France Statistical Centre Department of Public Health University of Ghent Laboratory Centre National Public Health Institute, Helsinki, Finland Coordination

  39. Unrestricted educational grants to the European Society of Cardiology AstraZeneca Bristol-Myers Squibb GlaxoSmithKline Pfizer Sanofi-Aventis Servier Merck /Schering-Plough Novartis Sponsors

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