Cardiovascular Disease Management Impacts Survival Outcomes

A new study reveals that nearly a quarter of patients with chronic ischemic cardiovascular disease (CICD) are dead or hospitalized within six months of diagnosis.

Researchers at Pitie-Salpetriere Hospital (Paris, France), Kapodistrian University (Athens, Greece), and various other institutions participating in the European Society of Cardiology (ESC) CICD pilot registry enrolled 2,420 patients across 10 countries in order to prospectively describe characteristics, management strategies, and clinical outcomes of the disease. In an initial study, the researchers reported six-month outcomes, during which 2,203 of the patients were analyzed.

The results revealed that 23.7% of the patients experienced all-cause hospitalization or death, with 2.6% dying after inclusion. Patients who experienced all-cause hospitalization or death were older, had a prior history of non-ST-segment elevation myocardial infarction (non-STEMI), chronic kidney disease (CKD), peripheral revascularization, and/or chronic obstructive pulmonary disease (COPD) than those without such events. A higher rate of events was observed in eastern, western, and northern countries, when compared to southern countries. The study was published on January 16, 2018, in European Journal of Preventive Cardiology.

“The rate of prescription of angiotensin converting enzyme inhibitors, beta-blockers, and aspirin was lower at six months compared to the start of the study; in absolute numbers the reductions were modest, but they did reach statistical significance,” said lead author Professor Michel Komajda, MD, of Pitie-Salpetriere Hospital. “This shows that patients have a better chance of receiving recommended medications while in hospital or directly after an outpatient appointment. Six months later, drugs they should be taking to reduce the risk of death and rehospitalization are prescribed less frequently.”

“Patients are at high risk of dying or being rehospitalized in the short-term, and should be carefully monitored by physicians,” concluded Professor Komajda. “We identified clinical factors which are strongly associated with this high risk which can easily be assessed. It is likely that there is insufficient handover of these patients to a cardiologist or GP, and so their prescriptions are not renewed.”

CICD remains one of the leading causes of mortality and morbidity worldwide. Several explanations, including an aging population, the rise in the prevalence of comorbidities, and the difficulties associated with access to medical care have been put forward to explain the difference between the expected benefit and real-life morbidity and mortality. New diagnostic tools, increased awareness of preventive measures, and the wide dissemination of revascularization procedures appear insufficient to reverse the poor outcomes.

Related Links:
Pitie-Salpetriere Hospital
Kapodistrian University