Key result
Stable CAD patients managed by cardiologists had a 1-year mortality of 2.2% and a 91.7% persistence to optimal medical therapy, with increasing age predicting lower persistence (OR 0.98).
Why the study?
To evaluate 1-year clinical events, pharmacological management, and quality of life in a contemporary cohort of stable CAD patients managed by cardiologists.
Observational (n=5,070)
Yes
Odds Ratio: 0.98 (95% CI 0.97–0.99)
p-value: p=0.04
In a contemporary Italian registry, stable CAD patients managed by cardiologists had a high rate of clinical events at 1 year, but maintained high persistence to optimal medical therapy and reasonable quality of life.
Supports cardiologist-led care for OMT persistence in stable CAD; leaves open age-related adherence barriers and causal links to outcomes.
AIMS: We evaluated the 1-year clinical events, pharmacological management, and quality of life in a contemporary cohort of stable coronary artery disease (CAD) patients managed by cardiologists. METHODS AND RESULTS: START (STable Coronary Artery Diseases RegisTry) was a prospective, observational, nationwide study that enrolled 5070 stable CAD patients over 3 months in 183 cardiology centres in Italy. At 1 year, 4790 (94.5%) patients had data on vital status. Death occurred in 107 (2.2%) patients and the cause of death was cardiovascular in 41 (38.3%) of cases. Among the 4775 patients with follow-up data on clinical events available, a hospitalization due to cardiovascular and non-cardiovascular causes occurred in 523 (11.0%) and in 231 (4.8%) of cases, respectively. Over 60% of patients reported as 'no problems' in all domains (61.4-84.5%) of the EuroQoL quality of life 5D-5L questionnaire. Among the 3239 patients with clinical visit/telephone interview at follow-up, in whom optimal medical therapy (OMT; aspirin or thienopyridine, β-blocker, and statin) was prescribed at enrolment, 2971 (91.7%) were still receiving OMT at follow-up. At multivariable analysis, only increasing age (odds ratio 0.98; 95% confidence interval 0.97-0.99; P = 0.04) resulted as independent negative predictor of OMT persistence at 1 year from enrolment. CONCLUSION: In this large, contemporary registry, stable CAD patients managed by cardiologists presented a high rate of clinical events at 1 year. Nevertheless, the persistence to OMT and quality of life appeared reasonable.
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Luca et al. (2019) conducted an observational in Stable coronary artery disease (n=5,070). Management by cardiologists was evaluated on Optimal medical therapy (OMT) persistence at 1 year (predictor: increasing age) (OR 0.98, 95% CI 0.97-0.99, p=0.04). Stable CAD patients managed by cardiologists had a 1-year mortality of 2.2% and a 91.7% persistence to optimal medical therapy, with increasing age predicting lower persistence (OR 0.98).
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