Secondary prevention following hospitalization for coronary artery disease: results from the POLASPIRE III survey

Abstract Background Despite significant advances in the management of coronary artery disease (CAD), long-term outcomes remain heavily dependent on effective secondary prevention. Previous editions of the POLASPIRE survey highlighted substantial gaps in the implementation of recommended preventive strategies in Poland. POLASPIRE III was designed to provide an updated, contemporary assessment of secondary prevention performance in everyday clinical practice. Objectives To evaluate the current level of implementation of European guidelines on secondary prevention among patients with established CAD with particular focus on the control of modifiable cardiovascular risk factors. Methods POLASPIRE III was a cross-sectional, multicenter survey designed to assess the implementation of European guidelines for the secondary prevention of CAD. Fifteen cardiology departments across ten administrative regions in Poland participated in the survey. Eligible patients were adults aged ≥18 years who had been hospitalized for an acute coronary syndrome or undergone a myocardial revascularization procedure. Participants were recruited and interviewed 6–18 months after discharge. Data were collected between January and August 2025, using standardized procedures and identical instruments across all participating centers. All research staff underwent centralized training to ensure uniformity in data collection and interview techniques. An uncontrolled risk factor was defined as failure to achieve the guideline-recommended treatment target at the time of the assessment. Results 832 patients (72.8% male; median age: 66.2 58.4-72.9 years among men vs. 70.7 65.1-75.7 years among women, p0.05) were examined. Blood pressure above guideline targets was found in 57.7% of patients (defined as ≥140/90 mmHg in individuals ≥80 years and ≥130/80 mmHg in those 80 years). The proportion of patients with high low-density lipoprotein cholesterol was 57.5% among men vs. 47.6% among women (p0.05). Hypertriglyceridemia was present in 41.9% of participants and high HbA1c level among 10.9%. 76.4% of participants (76.4% of men and 70.3% of women; p0.05) were overweight/obese and 14.3% of participants were active smokers. 51.4% of patients continued smoking after a cardiovascular event. The proportion of patients taking at least one β-blocker was 85.9%, an angiotensin converting enzyme inhibitor (65.3%), a sartan 85.8% and statins 85.9%. Conclusions The results of the study indicate that, in Poland, substantial gaps persist in achieving the recommended targets for secondary prevention following hospitalization for CAD. Actual control of major modifiable risk factors remains insufficient. These findings highlight the need for more structured and systematically implemented preventive cardiology programs, improved long-term follow-up, and greater emphasis on patient education. Strengthening these elements is essential to improving long-term outcomes in patients with established CAD.