Lancet: Doctors aren't applying best practices in treating EU heart patients

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Heart disease prevention in routine clinical practice is inadequate, with only a third of patients being referred to and joining prevention and rehabilitation programs, while doctors are prescribing more drugs. Saving people's lives from acute MI is not sufficient, and an urgent investment in prevention is needed to address the lifestyle causes of heart disease, according to study in the March 12 issue of the Lancet.

The study will presented at the American College of Cardiology (ACC) conference this month in Orlando, Fla.

The first (1995) and second (1999) EUROASPIRE (European Action on Secondary and primary Prevention by Intervention to Reduce Events) surveys showed that in coronary patients cardiovascular risk factors such as smoking, high blood pressure and high cholesterol were poorly managed in people with heart disease in Europe. Despite national and international guidelines on the best practices to prevent heart disease, they reported a widening gap between what is recommended and the results achieved in clinical practice.

In the study, David Wood, MD, from Imperial College London, and colleagues report the third (2006) EUROASPIRE survey outcomes, examining more than a decade of heart disease prevention practices in 22 countries in Europe. The study collates data from all three surveys on medical treatment and risk factors in heart disease patients aged 70 years or younger (3,180 patients in the first survey, 2,975 in the second and 2,392 in the third), interviewed about a year after a cardiac event.

The researchers said that their findings showed a continuing and widening gap between the guidelines and patients' lifestyles in terms of stopping smoking, reducing obesity and diabetes and substantial increases in doctors prescribing of all of the major classes of cardio-protective drugs.

"It is a matter of the greatest professional concern that so many coronary patients are not being managed to the standards set in European prevention guidelines and as a result are at increased risk of atherosclerotic disease and a shorter life expectancy," said Wood from the National Heart & Lung Institute in London.

The authors reported that more than 12 years there has been no reduction in the proportion of patients with heart disease who smoke (20.3 percent in EUROASPIRE I, 21.2 percent in II and 18.2 percent in III), but there has been a large increase in the proportion of younger female smokers. In addition, there has been a substantial increase in obesity and diabetes. In 1995, 25 percent of patients were obese and 17.4 percent had diabetes, this rose to 38 percent and 28 percent in 200.

Further, despite large increases in the use of all classes of blood pressure lowering drugs, blood pressure management showed no improvement. They reported that three out of five patients in all three surveys had raised blood pressure, and almost half of all patients remained above the recommended lipid targets. However, the number of patients with raised cholesterol has more than halved.

According to the authors, the results show how even when faced with a life-threatening disease it is difficult for people to change their behavior. "It is even harder when they don't have the professional support from a multidisciplinary team of nurses, dieticians, physiotherapists and doctors providing comprehensive prevention and rehabilitation programs," the authors wrote.

The researchers also pointed out that simply prescribing more cardioprotective drugs is clearly not enough and drug treatments need to be combined with professional lifestyle intervention.

Wood and colleagues concluded by calling for comprehensive lifestyle programs to be an integral part of healthcare provision and health insurance plans for all patients with heart disease.

In an accompanying commentary, Mette Brekke, MD, and Bjorn Gjelsvik, MD, from the University of Oslo in Oslo City, Norway, say that the results give three messages: "First, to help patients with coronary heart disease achieve a healthy lifestyle should be mandatory and have high priority for doctors and health authorities. Second, therapeutic targets...[such as blood pressure and lipid targets] are too ambitious and might take focus away from important lifestyle issues. Finally, political action is needed to reverse the negative trends of obesity and sedentary habits, ranging from fighting against the fast food and sugar industries to safe bicycle paths and healthy school meals." <br-->