Cardiac patients failing to meet secondary prevention risk factor targets
MedWire News: Results from an Australian study suggest that a substantial proportion of cardiac patients, particularly those who undergo percutaneous coronary intervention (PCI), are not achieving recommended risk factor targets for secondary prevention.
The findings were observed 6 weeks after patients (n=275) were discharged from hospital following acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, or PCI.
The researchers used the 2007 National Heart Foundation (NHF) of Australia Guidelines for Reducing Risk in Heart Disease and the 2001 NHF and Cardiac Society of Australia and New Zealand lipid management guidelines to define target levels for lifestyle (smoking, alcohol, physical activity, and waist girth) and physiological (total cholesterol, high-density lipoprotein [HDL] cholesterol, and blood pressure) risk factors.
Overall, 70.5% of patients were above the recommended targets for waist girth (≤80 cm for women and ≤94 cm for men), and 27.2% were below target for physical activity (≥150 min per week). Almost half of patients did not meet target levels for HDL cholesterol (>1.0 mmol/l [38.61 mg/dl]) or blood pressure (<130 mmHg for systolic and <80 mmHg for diastolic), and 27.2% were over target for total cholesterol (<4.0 mmol/l [154.44 mg/dl]).
However, guidelines for non-smoking and restricted alcohol consumption (≤1 alcoholic drink per day for women and ≤2 per day for men) were met by 95.2% and 87.4% of patients, respectively, say Barbara Murphy, from the University of Melbourne in Victoria, and colleagues.
Writing in the journal Heart, Lung, and Circulation, they add that for several areas, PCI patients had elevated cardiac risk compared with patients who suffered an AMI or underwent CABG surgery.
Specifically, 65.8% and 36.0% of PCI patients were over the blood pressure and total cholesterol targets, compared with 41.6% and 28.4% of AMI patients, and 40.9% and 20.2% of CABG patients, respectively.
PCI patients, compared with AMI and CABG patients, were also more likely to smoke (8.2% vs 6.8% and 0.9%, respectively) or drink alcohol above the recommended levels (23.6% vs 5.7% and 10.9%).
The researchers suggest that the lack of lifestyle change observed amongst PCI patients "may be due to the minimally invasive nature of the procedure, and patients' perception of PCI as a cure rather than a symptomatic treatment."
Murphy and team say that these findings emphasize the important role of general practitioners, outpatient cardiac rehabilitation, and other secondary prevention strategies.
"The majority of patients measured above the recommended waist girth, highlighting abdominal obesity as a key risk factor amongst Australian cardiac patients," they conclude.
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By Nikki Withers