EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease: Principal results

Abstract

BACKGROUND: The three major European scientific societies in cardiovascular medicine--the European Society of Cardiology (ESC), the European Atherosclerosis Society and the European Society of Hypertension--published in October 1994 joint recommendations on prevention of coronary heart disease in clinical practice. Patients with established coronary heart disease, or other major atherosclerotic disease, were deemed to be the top priority for prevention. A European survey (EUROASPIRE) was therefore conducted under the auspices of the ESC to describe current clinical practice in relation to secondary prevention of coronary heart disease. AIMS: The aims of EUROASPIRE were (i) to determine whether the major risk factors for coronary heart disease are recorded in patients medical records; (ii) to measure the modifiable risk factors and describe their current management following hospitalization, and (ii) to determine whether first degree blood relatives have been screened. METHODS: The survey was conducted in selected geographical areas and hospitals in nine European countries. Consecutive patients (< or = 70 years) were identified retrospectively with the following diagnoses: coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction and acute myocardial ischaemia without infarction. Data collection was based on a retrospective review of hospital medical records and a prospective interview and examination of the patients. RESULTS: 4863 medical records were reviewed of whom 25% were women, and 3569 patients were interviewed (adjusted response rate 85%) with an average age of 61 years. Nineteen percent of patients smoked cigarettes, 25% were overweight (BMI > or = 30 kg.m-2), 53% had raised blood pressure (systolic BP > or = 140 and/or diastolic BP > or = 90 mmHg), 44% had raised total plasma cholesterol (total cholesterol > or = 5.5 mmol.l-1) and 18% were diabetic. Reported medication at interview was: antiplatelet drugs 81%, beta-blockers, 54% (58% in post-infarction patients). ACE inhibitors 30% (38% in post infarction patients) and lipid lowering drugs 32%. Of the patients receiving blood pressure lowering drugs (not always prescribed for the treatment of hypertension) 50% had a systolic BP > 140 mmHg and 21% > 160 mmHg, and of those receiving lipid lowering drugs, 49% had plasma total cholesterol > 5.5 mmol.l-1 and 13% > 6.5 mmol.l-1. Thirty-seven percent of patients had a family history of premature coronary heart disease in a first-degree blood relative, but only 21% of patients reported being advised to have their relatives screened for coronary risk factors. CONCLUSIONS: This European survey has demonstrated a high prevalence of modifiable risk factors in coronary heart disease patients. There is considerable potential for cardiologists and physicians to further reduce coronary heart disease morbidity and mortality and improve patients chances of survival.