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February 15, 2017Archives of Medical ScienceOpen Access

Practice setting and secondary prevention of coronary artery disease

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Why the study?

Does the practice setting (primary care vs. specialist) affect the implementation of secondary prevention guidelines in patients with coronary artery disease?

Population

1,924 patients hospitalized due to acute coronary syndrome or for a myocardial revascularization procedure…

Comparison

Post-hospital care provided by primary care… vs Comparisons between the three practice settings…

Design

Cohort

Follow-up

6-18 months after hospitalization

Authors

PJPiotr JankowskiPreventive CardiologyDCDanuta CzarneckaElectrophysiologyLBLeszek BadaczKardio-Med Silesia

Discussion

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Member takes

Implication

Suboptimal LDL control persists despite rising statin use across settings; leaves open whether intensified strategies can improve goal attainment in CAD.

Structured PICO

Does the practice setting (primary care vs. specialist) affect the implementation of secondary prevention guidelines in patients with coronary artery disease?

P
Population
1,924 patients hospitalized due to acute coronary syndrome (myocardial infarction, unstable angina) or for a myocardial revascularization procedure (PCI, CABG) in southern Poland. Mean age 61.8 years, 67.2% male.
I
Intervention
Post-hospital care provided by primary care physicians, hospital outpatient clinics/cardiologists, or private cardiology practices.
C
Comparator
Comparisons between the three practice settings and across four time periods (1997-1998, 1999-2000, 2006-2007, 2011-2013).
O
Outcome
Implementation of cardiovascular prevention guidelines, assessed by control of risk factors (smoking, blood pressure, LDL cholesterol, BMI, fasting glucose) and prescription of cardioprotective medications 6-18 months after hospitalization.surrogate

Despite significant increases in the prescription of cardioprotective medications over a 15-year period, the control of cardiovascular risk factors such as LDL cholesterol and smoking remains suboptimal in CAD patients across all practice settings.

Limitations

  • Unidentified differences between practice setting groups may exist
  • Inability to assess the impact of differences in secondary prevention implementation on the risk of cardiovascular events
  • Participants limited to those who had undergone an acute CAD event or revascularization procedure, not representative of all CAD patients
  • Potential participation bias where patients in better condition could decide more often not to participate

Cite This Study

Jankowski et al. (2017) studied this question.

synapsesocial.com/papers/6a7e504ffff18652e232f697https://doi.org/10.5114/aoms.2017.65236
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Five-Year Prognosis in an Incident Cohort of People Presenting with Acute Myocardial Infarction2011 · 34 citations
  2. 2EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries2015 · 1,021 citations
  3. 3Secondary prevention in patients after hospitalisation due to coronary artery disease: what has changed since 2006?2014 · 15 citations
  4. 4Is the Physician’s Behavior in Dyslipidemia Diagnosis in Accordance with Guidelines? Cross-Sectional Escarval Study2014 · 30 citations
  5. 5European guidelines on cardiovascular disease prevention in clinical practice Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts)2003 · 2,256 citations