Cardiovascular therapy, diagnostic procedures, and control of risk factors in patients with diabetes or coronary artery disease in Poland: the Kardia‑Pol registry

Practice setting and secondary prevention of coronary artery disease

INTRODUCTION

Patients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. The aim of the analysis was to compare time trends in the extent to which cardiovascular prevention guidelines have been implemented by primary care physicians and specialists.

MATERIAL AND METHODS

Five hospitals with cardiology departments serving the city and surrounding districts in the southern part of Poland participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after hospitalization. The surveys were carried out in 1997-1998, 1999-2000, 2006-2007 and 2011-2013.

RESULTS

The proportion of smokers increased from 16.0% in 1997-1998 to 16.4% in 2011-2013 among those who declared that a cardiologist in a hospital outpatient clinic decided about the treatment, from 17.5% to 34.0% (p < 0.01) among those treated by a primary care physician, and from 7.0% to 19.7% (p = 0.06) among patients treated in private cardiology practices. The corresponding proportions were 44.6% and 42.4% (p < 0.01), 47.7% and 52.8% (p = 0.53), 44.2% and 42.2% (p = 0.75) for high blood pressure, and 42.5% and 71.2% (p < 0.001), 51.4% and 79.6% (p < 0.001), 52.4% and 72.4% (p < 0.01) for LDL cholesterol level not at recommended goal. The proportion of patients prescribed cardioprotective medications increased in every analyzed group.

CONCLUSIONS

The control of cardiovascular risk in CAD patients has only slightly improved since 1997/98 in all health care settings. The greatest potential for further improvement was found among patients whose post-hospital care is provided by primary care physicians. It is associated with promotion of a no-smoking policy and enhanced prescription of guideline-recommended drugs.

Antiplatelet and anticoagulant therapy in elderly people with type 2 diabetes mellitus in Poland (based on the PolSenior Study)

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is an important and common cardiovascular risk factor. The purpose of the study was to evaluate the frequency of use of oral antiplatelet drugs (OAPs) and oral anticoagulant drugs (OACs) among the elderly with T2DM in Poland.

MATERIAL AND METHODS

The study was based on the data collected in the Polish national PolSenior study.

RESULTS

Among 4979 PolSenior participants aged 65 and over, 883 (17.8%) had previously diagnosed T2DM. Among them, 441 (49.9%) used at least one drug in pharmacological cardiovascular prevention, i.e. OAPs (mostly ASA) in 405 (45.9%) cases and OACs in 38 (4.3%). The use of these drugs significantly depended on the sex (p = 0.02) and personal income (p = 0.05). Age, place of residence and level of education did not affect the prevalence of pharmacological prevention. Previous stroke and myocardial infarction were mostly associated with OAPs, whereas a history of atrial fibrillation (AF) was related to OAC treatment. Among participants treated with OAPs, therapy was applied as secondary cardiovascular prevention in 211 (52.1%) subjects, and as primary prevention in 194 (47.9%) subjects. Among participants treated with OACs, 24 (64.9%) persons had a history of AF. Secondary cardiovascular pharmacological prevention should be considered in 45 untreated participants (12.5%), and primary cardiovascular pharmacological prevention (SCORE ≥ 10 and/or AF) in 154 participants (42.7%).

CONCLUSIONS

Cardiovascular pharmacological prevention in the elderly with T2DM in Poland seems to be unsatisfactory. Educational programmes concerning current recommendations for pharmacological cardiovascular prevention should be developed among general practitioners.