The large majority of coronary patients in Europe are failing to achieve their lifestyle, risk factor and therapeutic targets as set out in the latest prevention guidelines. Fewer than one half of all European patients following a heart attack are even receiving the benefits of cardiac rehabilitation and preventive care.
In the light of the findings, from EUROASPIRE IV, largest survey of coronary care in Europe, the investigators 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, they add, 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.
EUROASPIRE IV is an ongoing survey run under the auspices of the European Society of Cardiology EURObservational Research Programme. This latest survey was undertaken at 78 centres in 24 European countries. A total of 16,426 medical records were reviewed and 7998 coronary patients identified and interviewed. The median time between index event and interview was 1.35 years. The results of the survey are reported in the European Journal of Preventive Cardiology.
Throughout the two decades of EUROASPIRE surveys, results have reflected continuing adverse lifestyle trends, in particular an evident increase in obesity and a persistently high prevalence of smoking in younger patients. This latest survey, performed throughout 2012 and 2013, shows emphatically that these trends continue. For example:
In reviewing the results the investigators note considerable variation between European countries in lifestyle and risk factor management, the use of cardioprotective medication, and the provision of rehabilitations services. Indeed, despite the strength of evidence, cardiac prevention and rehabilitation in Europe continues to be widely underused, they say, with enormous heterogeneity in service provision between countries. Overall less than one-half of coronary patients access such services.
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, described the results as "very disappointing."
She said: "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. 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."
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