Evaluation of secondary prevention of coronary heart disease. Results of the EUROSPIRE study in the Munster region

BACKGROUND: New recommendations for secondary prevention of coronary heart disease (CHD) were issued by the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS) and the European Society of Hypertension (ESH) in 1994. The main objective of the EUROASPIRE study (European Action on Secondary Prevention by Intervention to Reduce Events) was to evaluate to what degree the new recommendations have been implemented and whether a significant risk factor reduction in patients who presented with CHD has been achieved. The present study was conducted in the region of Munster, Westphalia, Germany, as part of the nine-country EUROASPIRE study. METHODS: A total of 524 patients (58.6 +/- 8.2 years) were included in the study by abstracting data from their medical records. According to the clinical event which led to admission to the hospital, patients belonged to the following four groups: 1) coronary artery bypass graft (CABG), 2) percutaneous transluminal coronary angioplasty (PTCA), 3) acute myocardial infarction, 4) acute myocardial ischemia. Initially, a pre-specified number of patients had been recruited with the goal of having 100 patients in each of the four groups participate in the follow-up interview and examination. At least 6 months and, on average, 20 months after hospital discharge for the acute event, 74.8% of the patients came to an interview and examination for an evaluation of their risk profile. RESULTS: At the interview, 15.6% of the patients smoked, 22.7% were obese, 54.6% had blood pressure levels above 140/90 mm Hg and 31.3% a total cholesterol/HDL-cholesterol-ratio greater than 5. Risk factor modification over time was insufficient as only one-fifth of patients had values of their risk factors within the target range at the time of the interview. CONCLUSION: The goals of secondary prevention have not been achieved in the region of Munster-there is clearly room for improvement. Considering the treatment of patients with CHD, the recommended strategies of secondary prevention need to be applied more intensively in clinical practice.