[Cracovian Program for Secondary Prevention of Ischaemic Heart Disease. The quality of care in the field of secondary prevention of ischaemic heart disease depends on where patients are treated in the postdischarge period]

Abstract

Even though the majority of actions undertaken within the secondary prevention ischaemic heart disease should be initiated while the patient is still hospitalized, the maximal benefit (measured as decreased cardiovascular risk) achieved depends mostly on the continuation and modifications of those actions in the post-discharge period. There is not much known about the quality of medical care provided for patients after hospitalization due to ischaemic heart disease. The aim of the study was to assess the quality of post-discharge care in the field of secondary prevention of ischaemic heart disease in patients treated in hospital outpatients (HO), private practice (PP), and by general practitioners (GP).

Methods: Consecutive patients (age>70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: acute myocardial infarction, unstable angina, coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. Risk factors and medication used were assessed 6-18 months after discharge.

Results: There was no significant differences in smoking, high blood pressure (>140/90 mmHg), and high fasting glucose (>6.0 mmol/l) between the study groups. High total cholesterol was found in 57.5%, 71.2% (p<0.05 vs HO) and 76.2% (p<0.05 vs HO) patients from HO, GP and PP group, respectively. Antiplatelet drugs were used in 83.5%,72.9% (p<0.05vs HO) and 67.4% (p<0.05vsHO), beta-blockers in 65.4%, 54.2% (p<0.05<HO) and 62.8%, lipid-lowering drugs in 48.9%, 18.6% (p<0.0001 vs HO) and 34.9% in HO, GP and PP group, respectively.

Conclusion: Hypercholesterolemia management as well as use of antiplatelets was the best in hospital outpatients.