Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)
Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute corona...
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BMJ Publishing Group
2021-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/1/e001659.full |
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| author | David Moore Catriona S Jennings Laura Murphy Conor Judge Peter Kearney John William McEvoy David Wood Kornelia Kotseva Thomas J Kiernan Ross T Murphy James Crowley Patricia Hall Bryan Traynor James O'Neill James MG Curneen Anthony Buckley Lavanya Saiva Donal Murray Sean Fleming Godfrey Aleong Bridog Nicaodhabhui John Birrane Irene Gibson |
| author_facet | David Moore Catriona S Jennings Laura Murphy Conor Judge Peter Kearney John William McEvoy David Wood Kornelia Kotseva Thomas J Kiernan Ross T Murphy James Crowley Patricia Hall Bryan Traynor James O'Neill James MG Curneen Anthony Buckley Lavanya Saiva Donal Murray Sean Fleming Godfrey Aleong Bridog Nicaodhabhui John Birrane Irene Gibson |
| author_sort | David Moore |
| collection | DOAJ |
| description | Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world. |
| format | Article |
| id | doaj-art-343de7cfe07a42a3b0667a99b456483d |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
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| series | Open Heart |
| spelling | doaj-art-343de7cfe07a42a3b0667a99b456483d2024-11-11T15:40:08ZengBMJ Publishing GroupOpen Heart2053-36242021-02-018110.1136/openhrt-2021-001659Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)David Moore0Catriona S Jennings1Laura Murphy2Conor Judge3Peter Kearney4John William McEvoy5David Wood6Kornelia Kotseva7Thomas J Kiernan8Ross T Murphy9James Crowley10Patricia Hall11Bryan Traynor12James O'Neill13James MG Curneen14Anthony Buckley15Lavanya Saiva16Donal Murray17Sean Fleming18Godfrey Aleong19Bridog Nicaodhabhui20John Birrane21Irene Gibson22Cardiology, Tallaght University Hospital, Dublin, IrelandNational Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland1 Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, UKSchool of Medicine, College of Medicine, Nursing and Health Science, University of Galway, Galway, IrelandCardiology, Cork University Hospital Group, Cork, IrelandNational Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, IrelandNational Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, IrelandNational Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, IrelandCardiology, University of Limerick Hospitals Group, Limerick, IrelandCardiology, Saint James`s Hospital, Dublin, IrelandDepartment of Cardiology, Galway University Hospitals, Galway, IrelandNational Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, IrelandNational Institute on Aging Laboratory of Neurogenetics, Bethesda, Maryland, USACardiology, Connolly Hospital Blanchardstown, Blanchardstown, IrelandClinical Pharmacology and Therapeutics, Galway University Hospital, Galway, IrelandCardiology, University of Limerick Hospitals Group, Limerick, IrelandCardiology, Connolly Hospital Blanchardstown, Blanchardstown, IrelandCardiology, Sligo University Hospital, Sligo, IrelandCardiology, Midland Regional Hospital Portlaoise, Portlaoise, IrelandCardiology, Letterkenny University Hospital, Letterkenny, IrelandMedicine, Galway University Hospital, Galway, IrelandMedicine, Galway University Hospital, Galway, IrelandSchool of Medicine, University of Galway, Galway, IrelandBackground Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.https://openheart.bmj.com/content/8/1/e001659.full |
| spellingShingle | David Moore Catriona S Jennings Laura Murphy Conor Judge Peter Kearney John William McEvoy David Wood Kornelia Kotseva Thomas J Kiernan Ross T Murphy James Crowley Patricia Hall Bryan Traynor James O'Neill James MG Curneen Anthony Buckley Lavanya Saiva Donal Murray Sean Fleming Godfrey Aleong Bridog Nicaodhabhui John Birrane Irene Gibson Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) Open Heart |
| title | Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) |
| title_full | Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) |
| title_fullStr | Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) |
| title_full_unstemmed | Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) |
| title_short | Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study) |
| title_sort | interhospital and interindividual variability in secondary prevention a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome the iaspire study |
| url | https://openheart.bmj.com/content/8/1/e001659.full |
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