Prevención secundaria de la cardiopatía isquémica tipo ángor y post-infarto agudo de miocardio en Atención Primaria

Auditing secondary prevention of ischaemic heart disease in rural areas of Spain: an opportunity for improvement

AIM

To describe the standard of secondary prevention received by individuals with a history of ischaemic heart disease (IHD) in Spanish rural areas, and the factors associated with low standards of quality.

METHODS

Medical audit of patients with a history of IHD, whose data were provided by 72 rural physicians in 12 autonomous regions (1030 cases). Quality criteria were used based on international guidelines. Multivariate analysis was employed to assess the variables associated with poor-quality attention.

RESULTS

30.9% of patients gave target low-density lipoprotein (LDL) readings, and 68.1% reached target blood pressure (BP). Beta-blockers were taken by 48.5%. Twenty-nine per cent of patients had not visited a specialist within the previous year. The fact that patients had visited a specialist within the previous year was associated with their having followed the types of treatments recommended in the guidelines (p < 0.01) and with obtaining target LDL and BP readings (p < 0.05). Patients from the smallest villages had the lowest probability of having LDL controls and also of receiving hypolipidaemic therapy (p<0.01). Those with a past history of isolated angina had lower probability of being treated with antiaggregants than those who had experienced previous acute myocardial infarction (p < 0.01).

CONCLUSION

The quality of secondary prevention for these patients shows there is room for improvement. Problems of accessibility exist for some groups, which may be improved with the involvement of rural primary healthcare teams.

[The secondary prevention of ischaemic heart disease in Spain. A systematic review of observational studies]

OBJECTIVE

To describe the use of ischaemic heart disease (IHD) secondary prevention measures in the Spanish National Health System.

DESIGN

Systematic review of observational studies with information on the use of preventive treatment and measures in the prevention of secondary IHD.

SETTING

Primary care and specialised out-patient clinics.

DATA SOURCES

Medline search and complementary searches of studies published between 1995 and 2004 with a description of the use secondary prevention measures on hospital discharge or in the follow up after discharge.

SELECTION OF STUDIES

A total of 125 references were found after the MEDLINE search, 13 of which were selected after an independent review by 2 researchers. The complementary sources provided 9 more studies giving a total of 22.

DATA EXTRACTION

One researcher extracted information on the characteristics of the study and the results variables, which were independently verified by a second evaluator. RESULTS. In the 22 studies found, a high level of variation was shown in the different treatment rates: anti-aggregants (at discharge, 72%-97.1%; follow-up, 46.4%-93.8%); beta-blockers (at discharge, 29%-68.3%; follow-up, 22.4%-59.0%); drugs with action on the renin-angiotensin system (at discharge, 16.2%-52.2%; follow-up, 6.1%-53.1%); lipid lowering drugs (at discharge, 6.7%-88.7%; follow-up, 24.5%-89.5%). The treatment rates showed a progressive improvement over time during the period studied.

CONCLUSIONS

In the period 1994-2003 treatment rates in the secondary prevention of IHD have increased, although there is still much room for improvement.