To describe lifestyle and risk-factor management in patients attending cardiac rehabilitation programmes (CRPs) compared to those who do not.
A cross-sectional survey.
The EUROASPIRE III survey was ...conducted in 76 centres in 22 European countries. Consecutive patients having had a coronary event or revascularization before the age of 80 were identified and interviewed at least 6 months after hospital admission.
13,935 medical records were reviewed and 8845 patients interviewed (participation rate 73%); 44.8% of patients reported being advised to attend a CRP and of these 81.4% did so (36.5% of all patients). There were wide variations between countries and diagnostic categories, ranging from 15.9% in the Ischaemia group to 68.1% in the CABG group. Characteristics associated with participation in a CRP included younger age, male sex, higher educational level and CABG as a recruiting index event, while smokers were less likely to attend a CRP. Patients who attended a CRP had a significantly lower prevalence of smoking, better control of total and LDL-cholesterol and higher use of beta-blockers, ACE inhibitors/ARBs and lipid-lowering drugs.
CRPs in Europe are underused, with poor referral and low participation rate and wide variations between countries. Despite this heterogeneity, the control of smoking and cholesterol and the use of cardioprotective medication is better in those who attend a CPR. There is an urgent need for comprehensive, multidisciplinary rehabilitation programmes to integrate professional lifestyle interventions with effective risk-factor management, appropriately adapted to the medical, cultural and economic settings of a country.
Summary Background The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in ...2006–07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice. Methods EUROASPIRE I, II, and III were designed as cross-sectional studies and included the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, and Slovenia. Consecutive patients (men and women ≤70 years) were identified after coronary artery bypass graft or percutaneous coronary intervention, or a hospital admission with acute myocardial infarction or ischaemia, and were interviewed at least 6 months later. Findings 3180 patients were interviewed in the first survey, 2975 in the second, and 2392 in the third. Overall, the proportion of patients who smoke has remained nearly the same (20·3% in EUROASPIRE I, 21·2% in II, and 18·2% in III; comparison of all surveys p=0·64), but the proportion of women smokers aged less than 50 years has increased. The frequency of obesity (body-mass index ≥30 kg/m2 ) increased from 25·0% in EUROASPIRE I, to 32·6% in II, and 38·0% in III (p=0·0006). The proportion of patients with raised blood pressure (≥140/90 mm Hg in patients without diabetes or ≥130/80 mm Hg in patients with diabetes) was similar (58·1% in EUROASPIRE I, 58·3% in II, and 60·9% in III; p=0·49), whereas the proportion with raised total cholesterol (≥4·5 mmol/L) decreased, from 94·5% in EUROASPIRE I to 76·7% in II, and 46·2% in III (p<0·0001). The frequency of self-reported diabetes mellitus increased, from 17·4%, to 20·1%, and 28·0% (p=0·004). Interpretation These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease. Despite a substantial increase in antihypertensive and lipid-lowering drugs, blood pressure management remained unchanged, and almost half of all patients remain above the recommended lipid targets. To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention. Funding European Society of Cardiology through grants from Merck Sharp & Dohme (EUROASPIRE I); AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, and Pfizer (EUROASPIRE II); and AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Sanofi-Aventis, Servier, Merck/Schering-Plough, and Novartis (EUROASPIRE III).
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