The 197 participating hospitals were a mix of hospitals with non invasive diagnostic facilities only (33%), with both non-invasive and invasive cardiology(19%), and hospitals with both invasive cardiology and cardiac surgery on site (31%)
As expected, elderly had more concomitant diseases than younger patients. In general, however, the survey documents a relatively young population (mean age of 61) with a high prevalence of modifiable cardiovascular risk factors with mild to moderate angina without heart failure. These patients are at increased risk by virtue of their symptoms, but for the most part have not yet suffered major adverse cardiovascular events. They will benefit from intensive risk modification.
Yet, there is a clear gap between the guidelines and practice with regard to the management of cholesterol and glucose. For example,only 72% of patients had a cholesterol measurement performed within 4 weeks of assessment. Mean cholesterol level was 5.8 mmol/L, and just one-third of patients taking statin had achieved the target(5 mmol/L) cholesterol.
Coronary angiography (CAG) was planned or performed in 41% of patients, with considerable regional variation. There was frequently considerable delay before performance of the test. Exercise ECG as well as CAG were less often performed in elderly. Elderly who underwent exercise ECG and CAG more often had abnormal test resultsthan their younger counterparts (no significant narrowings in only 20% of those aged75 and over versus 5% in counterparts). Women were less likely to be referred for exercise ECG and CAG, even after multivariable adjustment.
Nevertheless, women more often had no significant narrowings than men. Antiplatelet and statin therapies were used significantly less in women than inmen, and women with confirmed coronary disease were less likely to be revascularised than their male counterparts and were twice as likely to suffer death or non fatal myocardial infarction during the 1-year follow-up period, even after multivariable adjustment.
Increasing intensity of guideline compliant therapy was associated with a reduction in death and myocardial infarction (MI) during follow-up in patients with angina and confirmed coronary disease (HR 0.68; 95% CI0-49-0.95 per unit increase in treatmentscore).
Conclusion: (1) Cardiovascular disease preventionshould be applied more often.(2) In the elderly, diagnostic procedurescould be used more frequently.(3) In women, non invasive and invasivediagnostic procedures should be consideredmore often as well as coronary revascularisation.(4) Guideline compliant medical therapy improvesclinical outcome in patients withstable angina and objective evidence ofcoronary disease.
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