In reviewing the results, researchers note significant variation between European countries in lifestyle and risk factor management, the use of cardioprotective medication, and the provision of rehabilitation services. They say that despite the strength of evidence, cardiac prevention and rehabilitation in Europe continues to be widely underused, with enormous heterogeneity in service provision between countries.
The researchers are now calling for "a new approach to cardiovascular prevention... which integrates cardiac rehabilitation and secondary prevention into modern preventive cardiology programmes with appropriate adaptation to medical and cultural settings in each country." Such an approach requires multidisciplinary teams and should involve both patients and their families in a bid to achieve prevention targets and improve quality of life and survival, the researchers point out.
EUROASPIRE IV is an ongoing survey run under the auspices of the European Society of Cardiology EURObservational Research Programme. This latest survey covered 78 centres in 24 European countries. A total of 16,426 medical records were reviewed and 7,998 coronary patients identified and interviewed. The median time between index event and interview was 1.35 years.
Throughout the two decades of EUROASPIRE surveys, results have indicated continuing adverse lifestyle trends, in particular a considerable increase in obesity and a persistently high prevalence of smoking in younger patients. This latest survey, conducted in 2012-2013, shows emphatically that these trends continue. For example:
- Nearly one-half of those who smoked before their cardiac event were still smokers at follow-up; the prevalence of smoking among these persistent smokers was highest in younger patients (under 50 years), both men and women. Stopping smoking after a heart attack is an effective preventive action, shown in several important studies to reduce coronary mortality by at least 36 percent. Despite this evidence, the researchers say, fewer than one in five of those still smoking were advised to attend a smoking cessation clinic, and only a small minority did so.
- A majority of coronary patients were overweight or obese, many with central obesity, contributing to the high prevalence of diabetes. Many obese patients were uninformed about their weight and nearly half did not follow any dietary recommendations or increase their physical activity levels. Many had no plans to lose weight.
- Glucose control in previously diagnosed diabetes was poor, with just over one-third achieving the target levels for HbA1c of 6.5 percent (a measure of sugar in blood) — and still less than half using the new target level of 7.0 mmol/l.
- A majority of coronary patients did report increasing physical activity levels and changing diet since hospitalisation. However, only four out of 10 achieved a physical activity level of moderate or vigorous intensity during at least 20 minutes on one or more occasions a week.
- Less than two-thirds of coronary patients had reached the conservative LDL cholesterol target of <2.5 mmol/l (and only one-fifth the 2012 target of <1.8 mmol/l), despite lipid-lowering therapy. "Coronary patients require more intensive cholesterol management," the researchers explain.
- Although information on hypertension was well recorded in discharge notes, less than one-third of coronary patients taking blood pressure medication had reached the recommended target (which at the time was 130/80 mmHg or below). A more conservative target of 140/90 mmHg was recommended in 2012 guidelines, but even this was not achieved by more than two-fifths of the patients.
The results are "very disappointing," says the study's first author and Chair of the EUROASPIRE Steering Committee, Dr. Kornelia Kotseva from the National Heart and Lung Institute, Imperial College London.
"A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes. Risk factor control is inadequate despite high reported use of medications and there are large variations in secondary prevention practice between centres," Dr. Kotseva notes.
"Despite the existence of clear, evidence-based guidelines, their integration into routine clinical care remains disappointing, and there is still much room to raise the standards of preventive cardiology throughout Europe."
Source: European Society of Cardiology
Image Credit: Dr. Kornelia Kotseva/European Society of Cardiology