Progress in prevention: secondary prevention of primary importance.
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Cardiovascular Diseases↗
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Results for “Secondary Prevention”
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[The practical aspects of lipid management in secondary prevention].
Secondary prevention of ischaemic heart disease includes the important aim of reducing plasma lipids, as have been suggested by several recent trials focusing both on plaque regression-stabilization and on mortality (4S). The degree of acceptance of recommendations of the different panels of experts, however, has been low. Implementation of these secondary prevention measures in clinical practice requires the understanding of their pathophysiologic and epidemiologic basis, as well as an appropriate spread of experts recommendations and a good relationship of the different levels of health care to cardiac patients.
Coronary Disease↗
Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents.
Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.
Adolescent↗
Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention.
OBJECTIVE: To investigate whether population based primary prevention (risk factor reduction in apparently healthy people) might be more powerful than current government initiatives favouring risk factor reduction in patients with coronary heart disease (CHD) (secondary prevention). DESIGN, SETTING, AND PARTICIPANTS: The IMPACT model was used to synthesise data for England and Wales describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in healthy people and in CHD patients. RESULTS: Between 1981 and 2000, CHD mortality rates fell by 54%, resulting in 68,230 fewer deaths in 2000. Overall smoking prevalence declined by 35% between 1981 and 2000, resulting in approximately 29,715 (minimum estimate 20 035, maximum estimate 44,675) fewer deaths attributable to smoking cessation: approximately 5035 in known CHD patients and approximately 24,680 in healthy people. Population total cholesterol concentrations fell by 4.2%, resulting in approximately 5770 fewer deaths attributable to dietary changes (1205 in CHD patients and 4565 in healthy people) plus 2135 fewer deaths attributable to statin treatment (1990 in CHD patients, 145 in people without CHD). Mean population blood pressure fell by 7.7%, resulting in approximately 5870 fewer deaths attributable to secular falls in blood pressure (520 in CHD patients and 5345 in healthy people) plus approximately 1890 fewer deaths attributable to antihypertensive treatments in people without CHD. Approximately 45,370 fewer deaths were thus attributable to reductions in the three major risk factors in the population: some 36 625 (81%) in people without recognised CHD and 8745 (19%) in CHD patients. CONCLUSIONS: Compared with secondary prevention, primary prevention achieved a fourfold larger reduction in deaths. Future CHD policies should prioritise population-wide tobacco control and healthier diets.
Adult↗
[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease after discharge in 1997-98 and 1999-2000].
INTRODUCTION: Although most actions undertaken within the scope of the secondary prevention of ischaemic heart disease should be initiated during hospitalization, obtaining maximal effects (quantified by cardiovascular risk reduction) depends largely on continuation and appropriate adjustment of these measures in the post-discharge period. The aim of this paper is to assess the implementation of guidelines on secondary prevention of ischaemic heart disease in the period after discharge from the hospital in the years 1999/2000 as compared with 1997/98. MATERIAL AND METHODS: In the first phase 515 subjects hospitalized in cardiac departments of university and general hospitals in Cracow were included. Out of them, 427 patients attended the control visit 6-18 months after index hospitalization. Based on a standardized questionnaire a structured medical history was obtained including the presence of risk factors and medication. At the same time body height and mass and blood pressure were measured and blood samples were obtained for lipid profile and fasting glucose level. RESULTS: Elevated cholesterol levels (> or = 5.2 mmol/l) were observed in 65.8% of patients in 1998/99 and 66.3% in 1999/2000, high blood pressure (> or = 140/90 mmHg) in 46.2% and 50.4%, obesity (BMI > or = 30 kg/m2) in 24.6% and 27.2%, fasting hyperglycemia (> or = 6.0 mmol/l) in 17.7% and 27.4% (p < 0.05) and smoking in 16.3% and 15.9%, respectively. An increase was observed in the rate of antiplatelet (76.1% in 1998/99 vs 86.7% in 1999/2000, p < 0.001) and lipid lowering drug use (34.0% vs 41.9%, p < 0.05). The rate of beta-blockers and ACE inhibitors use did not change significantly. CONCLUSIONS: In the years 1999/2000 the control of main risk factors of ischaemic heart disease did not improve when compared with 1997/98. There was only an increase in the percentage of patients on antiplatelet and lipid lowering drugs. These results indicate that the dissemination of the guidelines for secondary prevention of ischaemic heart disease among physicians and patients remains one of the top priorities of cardiology in Poland.
Adrenergic beta-Antagonists↗
[Cracovian program for secondary prevention of ischemic heart disease. Secondary prevention of ischemic heart disease during hospitalization in 1996-97 and 1998-99].
INTRODUCTION: Hospitalization for ischaemic heart disease is a convenient moment to initiate pharmacological and non-pharmacological treatment as well as education of patients. The aim of the study was to assess the quality of medical care in the field of secondary prevention in patients hospitalized for ischaemic heart disease in cardiac departments of university and general hospitals in 1998/99 as compared with 1996/97. MATERIAL: Consecutive patients were recruited on the basis of hospital records review of six cardiac departments (three in the university and three in general hospitals) in 1998/99. Inclusion criteria were: age < or = 70 years, inhabitance in the city of Cracow and its province and hospitalization due to: myocardial infarction, unstable angina, coronary angioplasty or coronary-aortic bypass grafting. METHODS: Hospital records of the included patients were reviewed. Data on previous history of ischaemic heart disease, on risk factors (including smoking, hypertension, diabetes, dyslipidemia, obesity) and drugs prescribed at discharge were obtained based on a predefined questionnaire. RESULTS: The frequency of blood pressure measurement in the first 24 hours of hospitalization was 88.8% in 1996/97 vs 95.7% in 1998/99 (p < 0.001). In the first 24 hours after admission total cholesterol concentration was measured in 32.8% and 45.0% of patients (p < 0.001), HDL cholesterol in 30.2% and 41.9% (p < 0.001) and triglycerides in 32.3% and 44.5% (p < 0.001), respectively. Both height and body mass were documented in 54.3% and 61.7% (p < 0.05) of the reviewed charts. Antiplatelet drugs were prescribed at discharge in 86.7% and 90.7% of patients (p < 0.05), beta-blockers in 66.4% and 61.9%, ACE inhibitors in 50.2% and 52.8%, while lipid lowering drugs in 27.1% and 41.6% (p < 0.001), respectively. CONCLUSION: In 1998/99 compared with 1996/97 the quality of care in the field of secondary prevention of ischaemic heart disease was improved in cardiac departments of university and general hospitals in Cracow.
Adrenergic beta-Antagonists↗
[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part III. Secondary prevention of ischaemic heart disease after discharge].
UNLABELLED: Even though the majority of actions undertaken within the secondary prevention of ischaemic heart disease should be initiated while the patient is still hospitalized, the maximum benefit (measured as decreased cardiovascular risk) achieved depends mostly on the continuation and modification of these actions in the postdischarge 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 postdischarge care in the field of secondary prevention of ischaemic heart disease. METHODS: Consecutive patients (age > or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: acute myocardial infarction, unstable angina, CABG and PCI. Out of 536 patients 418 took part in the control visit 6-18 months after discharge. Risk factors and medication used were assessed. RESULTS: High total cholesterol (> or = 5.2 mmol/l) was found in 65.8% of patients, high blood pressure (> or = 140/90 mmHg) in 46.2%, obesity (BMI > or = 30 kg/m2) in 24.6%, fasting glucose over 6.0 mmol/l in 17.7% and smoking in 16.3%. The frequency of antiplatelet drugs and beta-blockers use decreased whereas that of lipid-lowering drugs increased in the postdischarge period. The highest frequency of use of antiplatelets and lipid-lowering drugs, as well as the best control of hypercholesterolemia was found in the PCI group, whereas the lowest frequency of smoking was found in the CABG group. CONCLUSIONS: Insufficient control of risk factors and the frequency of secondary prevention using drugs was found. There is a need to intensify secondary prevention in patients with ischaemic heart disease in the postdischarge period.
Adrenergic beta-Antagonists↗
[Prevention secondary to ischemic cardiopathy at the lipid level in primary care in Aragon. PRECIAR study 1].
BACKGROUND: Despite the existing evidence of the effectiveness of secondary prevention by modifying lifestyles or using the different drugs which have shown themselves to be clinically beneficial for heart patients, there is little, not highly accurate information available regarding the handling of the treatment of these patients within the scope of primary care in our country. The purpose of this study is that of ascertaining the current status of secondary prevention of heart disease as far as lipid control is concerned. METHODS: A review was made of the clinical records of all of the patients diagnosed at some point in time of their life as having ischemic heart disease, including those under the heading of acute myocardial infarction and angina pectoris within the 11 groups of patients assigned to three urban Health Care Centers in Area II in Zaragoza. The population in question totaled 19,692 patients, 388 cases of ischemic heart disease having been found in the record files data. RESULTS: Based on a study of the lipid control data, 60.8% of the cases analyzed in this study showed a complete lipid profile for the last year. Solely 4.7% of these patients had LDL < 100, the control objective having to be limited to c-LDL < 130 to find a 31.3% of patients with a lower than optimum control of this parameter. CONCLUSIONS: The results of our study reveal that the diagnosis of dyslipemias as well as the control of all other heart disease risk factors in secondary care have not been in keeping, for the most part, with the quality criteria of this health care procedure and therefore reveal the existence of a major degree of room for improvement.
Aged↗
[Prevention of chronic obstructive pulmonary disease (primary prevention and secondary prevention)].
Cigarette smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). The prevention of smoking initiation among teenagers and the encouragement of smoking cessation among smokers lead to preventing the onset and progression of COPD. Smoking cessation is the single most effective- and cost-effective-way to reduce the risk of developing COPD and stop its progression. Comprehensive tobacco control policies and programs, which involve some mix of public education, mass media campaigns, prevention of youth access to tobacco, school-based smoking prevention curricula, creation of smoke-free environment, and health professional training on cessation techniques should be delivered.
Adolescent↗
[The program for primary prevention and secondary prevention of ischemic coronary disease and research at the Laboratory of Human Energy Resources of the University of Wyoming in Laramie].
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Coronary Disease↗
[Intervention program to improve secondary prevention of myocardial infarction. Results of the PRESENTE (early secondary prevention) study].
INTRODUCTION AND OBJECTIVES: Secondary prevention measures for myocardial infarction are inadequate. In Spain, the earlier PREVESE studies provided preliminary data. The aim of this study was to document the results of a simple intervention program for secondary prevention, implemented during the hospital stay. PATIENTS AND METHODS: We included 4174 patients (mean age 63.7 years, 73% men) discharged from 110 hospitals after myocardial infarction. Lipid profile was determined during the first 24 h after admission, and before discharge patients and relatives were informed about the disease and its prevention, and were given printed informative materials. The patients were seen again 6 months later. RESULTS: After 6 months, 82.9% of the patients were examined and 10% were lost to follow-up. Mean blood pressure, weight and body mass index of the sample were lower, and lifestyle variables had improved. At discharge 87% were prescribed statins, 59.4% beta blockers, 51.2% ACE inhibitors and angiotensin blockers, and 94.1% antiplatelet drugs. These prescriptions were still being used 6 months later. There were substantial improvements in lipid values. CONCLUSIONS: The implementation of a simple intervention program for patients with myocardial infarction and their relatives, and the determination of lipid levels within 24 hours of admission, improved the secondary prevention measures at discharge and during the 6-month follow-up period. Acceptance of the program among the patients was good.
Aged↗
[Secondary prevention and cardiac rehabilitation in Spain. Section of Preventive Cardiology].
Secondary prevention and cardiac rehabilitation constitute both a unique strategy in the prevention of coronary heart disease. Comprehensive cardiac care must be considered one of the main objectives and the Spanish cardiologists dedicate less attention to it than to other cardiological procedures. Several international recommendations on secondary prevention and cardiac rehabilitation have been published during the last years, and both strategies have shown a good cost-benefit ratio. Several measures for secondary prevention, like reducing cholesterol levels in hypercholesterolaemic patients, and the treatment with aspirin, have also shown a decrease in CHD mortality and total mortality. Cardiac rehabilitation programmes improved some sociolaboral outcomes. In spite of those facts, the Spanish cardiologists pay little attention to secondary prevention and cardiac rehabilitation, as the results of two recently distributed questionnaires show.
Cost-Benefit Analysis↗
Comprehensive cardiac rehabilitation improves the control of dyslipidemia in secondary prevention.
BACKGROUND: Secondary prevention is an important goal of cardiac rehabilitation in patients with coronary heart disease (CHD). Dyslipidemia is one of the major risk factors that is important to control to reduce the incidence of future ischemic coronary events. The aim of the present study was to assess whether control of dyslipidemia, in secondary prevention, could be improved by a comprehensive cardiac rehabilitation program. METHODS: Fifty-two newly diagnosed hyperlipidemic men, who had experienced a recent CHD event, were separated in two equal groups of 26 patients: group CR+, in which patients were included in a 2-month cardiac rehabilitation program including an extensive educational program on cardiovascular risk factors, lipids, and diet, and group CR-without any cardiac rehabilitation. Mean age, body mass index, initial levels of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and LDL/HDL ratio were not significantly different between the 2 groups. In both groups, each patient was referred to a dietitian and to the same lipidologist to start an appropriate hypolipidemic treatment. Treatment of coronary event, type of hyperlipidemia, and hypolipidemic treatment were not different between the two groups. RESULTS: Lipid measurements, performed 3 months after the beginning of the hypolipidemic treatment, showed that patients from the CR+ group, compared with those from the CR-group, had a significantly greater reduction of total cholesterol (23% versus 13%; P < 0.001), of LDL cholesterol (28% versus 12%; P < 0.001), of LDL/HDL ratio (34% versus 13%; P < 0.01) and of triglycerides (33% versus 21%; P = 0.05). CONCLUSIONS: Patients with CHD included in a comprehensive cardiac rehabilitation program showed a significantly better response to the hypolipidemic treatment than patients without cardiac rehabilitation. These results could be attributable to the extensive educational program on secondary prevention performed during cardiac rehabilitation, leading to optimized knowledge on lipid-lowering diet and to improved diet and drug adherence. A secondary prevention educational program must be an important part of any comprehensive cardiac rehabilitation program in patients with CHD.
Adult↗
[Krakow Program for Secondary Prevention of Ischaemic Heart Disease. Part II. Secondary prevention of ischaemic heart disease during hospitalization].
UNLABELLED: Hospitalization due to ischaemic heart disease provides a possibility to introduce patients education, to initiate non-pharmacological treatment and to assure patient compliance. The aim the study was to assess the frequency of risk factors and the quality of care in the field of secondary prevention in patients hospitalized due to acute coronary syndromes or subjected to myocardial revascularization. METHODS: The study was carried out in cardiac departments of six hospitals serving the area of the city. Consecutive patients (age < or = 70 years; residing in the Cracow province) were identified according to the following clinical diagnoses or procedures: first or recurrent acute myocardial infarction, first or recurrent unstable angina, first coronary artery bypass grafting or first percutaneous coronary intervention. RESULTS: Data of 536 patients (140 women and 396 men; mean age--56.6 +/- 8.4 years; hospitalized from 1.07.1996 to 30.09.1997) were collected from medical records. The rate of blood pressure measurement during the first 24-hours of hospitalization was 88.8%. Total cholesterol, HDL cholesterol, and triglycerides were assessed in 32.8%, 30.2%, and 32.3% of patients respectively during the first 24-hours of hospitalization. The height and weight were found in 54.9% and 85.1% of medical records. Obesity (BMI > or = 30 kg/m2) was found in 20.3% of patients, 36.7% smoked, 56.0% had hypertension, 15.5% diabetes and 79.5% had hyper-cholesterolemia. Medication at discharge was: antiplatelet drugs 86.7%, beta-blockers 66.4%, ACE inhibitors 50.2% and lipid lowering drugs 27.1%. CONCLUSION: There is a need to initiate a comprehensive programme in order to improve quality of care in the field of secondary prevention of ischaemic heart disease.
Adult↗
Secondary prevention of coronary heart disease. Secondary prevention programmes may reduce overall mortality in high risk patients.
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Coronary Disease↗
A British Cardiac Society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events).
OBJECTIVE: To measure the potential for secondary prevention of coronary disease in the United Kingdom. DESIGN: Cross sectional survey of a representative sample of coronary patients from a retrospective review of hospital medical records and patient interview and examination. SETTING: Stratified random sample of 12 specialist cardiac centres and 12 district general hospitals drawn from 34 specialist cardiac centres and 261 district general hospitals in 12 geographic areas in the United Kingdom. SUBJECTS: 2583 patients < or = 70 yr; 25 consecutive males and 25 consecutive females identified retrospectively in each of four diagnostic categories: coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, and acute myocardial ischaemia without evidence of infarction. MAIN OUTCOME MEASURES: Risk factor recording and management in medical records; the prevalence and control of risk factors at interview six months after the procedure or event. RESULTS: Recording of coronary risk factors in patient's records was incomplete and this varied by risk factor. Smoking habit and blood pressure were most completely recorded, whereas a history of hyperlipidaemia and blood cholesterol concentrations were least complete. Risk factor records were more likely to be complete in cardiac centres than in district hospitals. At interview 10% to 27% of patients were still smoking cigarettes and 75% remained overweight, females more severely so. Up to a quarter of patients remained hypertensive, males more severely so than females. Over three quarters had a total cholesterol > 5.2 mmol/l. In patients on medication for blood pressure, cholesterol or glucose, risk factor profiles were little better than in those who were not. Only about one patient in three was taking a beta blocker after infarction. Up to a fifth of patients who had had acute myocardial ischaemia were not taking aspirin at follow up. CONCLUSIONS: There is considerable potential to reduce the risk of a further major ischaemic event in patients with established coronary disease. This can be achieved by effective lifestyle intervention, the rigorous management of blood pressure and cholesterol, and the appropriate use of prophylactic drugs.
Adrenergic beta-Antagonists↗
Calcium antagonists in secondary prevention after acute myocardial infarction: the Secondary Prevention Reinfarction Nifedipine Trial (SPRINT).
SPRINT was a double-blind, randomized placebo controlled multi-centre trial based in Israel, designed to test whether nifedipine 10 mg X 3 daily would reduce morbidity and mortality during 1 year follow-up in 2279 male and female survivors of acute myocardial infarction. 335 patients were adjudged to be trial deviations. 130 (5.7%) of patients died and 105 (4.6%) experienced a non-fatal myocardial reinfarction. Analysis of the results by trial medication is awaited.
Clinical Trials as Topic↗
[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].
UNLABELLED: 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.
Adrenergic beta-Antagonists↗