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Epidemiological data from the Heart Care Network Argentine. The First Argentine Multicenter Program on Secondary Prevention in Cardiology.

Ballerio Fernando; Cabo Fustaret Marcela; Covelli Guillermo and HCNA investigators

Heart Care Network Argentina

Abstract
Introduction
Objectives
Material and Methods
Results
Discussion
Conclusions


Abstract

In spite of largely demonstrated benefits of Secondary Prevention (SP), there were no multicenter programs to ensure an optimal management of risk factors (RF) in cardiovascular patients ( CVp) in our country. The HCNA was designed to improve control of RF and reach the international goals, using didactic materials and communication methods to involve CVp in their own care and collaborate with physicians in the follow-up.
Objective: to assess the percentage of p of high risk in the population recruited into the HCNA as a first step in the analysis of a SP multicenter program.
Material and Methods: information was stored in a database and statistically analyzed. From 10/97 to 12/98, 4532 CVp were enrolled in 27 institutions. Results: age 64,5 ± 11,86 years; female 25,6 %; BMI 27,62 ± 4,06; post-menopausal 78,1%; oral contraceptives 1,3%; family history 24,3%; smokers 18,2%; ex-smokers 42,3%; dislipidaemia 61,2%; diabetics 17,7%; hypertensives 57 %. Cardiovascular diagnoses(%); myocardial infarction 48,7; angor 52,1; heart failure 8,4; coronary angioplasty 23,1; myocardial revascularization surgery 18,4; arrhythmia 9,3; cerebrovascular event 5,7; peripheral vascular disease 7,0; valvular 2,6. The following values were found at baseline: systolic BP 132,92 ± 18,73 mmHg; diastolic BP 79,34 ± 11,07 mmHg; total cholesterol 221,7 ± 45,3 mg/dl; HDL 44,77 ± 11,36 mg/dl; LDL 142,72 ± 39,19 mg/dl; TG 170,39 ± 107,48 mg/dl; fasting glycemia 116,93 ± 46,37 mg/dl. Body exercise (%): None: 59,5; one time/week (t/w): 8,2; two t/w: 8,7; three t/w: 20; rehabilitation: 3,6.
Conclusions: In this population there is an important incidence of modifiable RF, which justify the implementation of the HCNA to optimize CVp’s care

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Introduction:

Cardiovascular disease is the leading cause of death in Argentina. During the last years a great amount of evidence show that patients with cardiovascular diseases of atherosclerotic origin may improve their survival when receiving appropriate prophylactic drugs and by reducing their cardiovascular risk factors. So, cardiovascular secondary prevention becomes a priority between cardiovascular patients, but in spite of these largely demonstrated benefits, little is done among them. With the purpose of getting into practice these benefits, we designed a multicentric secondary prevention program with the following aim: to improve the control of modifiable risk factors and to reach the international standards for them.

Objectives:

The purpose of this communication is to asses the prevalence of high risk population recruited into the Heart Care Network as a first step in the analysis of the patients in a secondary prevention programme.

Material and Methods:

The program uses didactic materials (fig. 1) and communicational methods to involve cardiovascular patients in their own care and to collaborate with physicians in the follow-up. The patients received oral and written information about the modifiable risk factors and the indications for their treatment. Each physician could use it own criteria to manage the patient’s therapy. Each center has a coordinator whose role is to keep a strict follow-up, ensuring a schedule visit every three months, during the first year and every 6-month there after. To be included the patients must have evidence of at least one of the following: stable angina, history of myocardial infarction, coronary artery bypass graft (CABG), percutaneus transluminal coronary angioplasty (PTCA), acute myocardial infarction (AMI), unstable angina, cerebrovascular event. The risk factors and the goals, based on the American Heart Association and European Society of Cardiology guidelines are:

Systolic blood pressure: < 140 mmHg.
Diastolic blood pressure: < 90 mmHg.
Total cholesterol: < 200 mg/dl
HDL cholesterol: > 35 mg/dl
LDL cholesterol: < 100 mg/dl
Triglycerides: < 200 mg/dl
Glycemia: < 120 mg/dl
Body mass index: < 27 Kgm/m2
Smokers: quit smoking
Avoid sedentarism

fig1.jpg (103696 bytes)
Figure 1

 

Treatment guidelines as in figure 2

fig2.gif (8485 bytes)
Figure 2

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Results:

Between October ’97 and December ’98 4532 patients were invited to participate in this programme among 27 institutions spread all over the country. The analysis of the database showed: mean age 64,5+11,86 years. Sex: 25,6 % were women, 78,1 % were post-menopausal and 1.3% were receiving oral anticonceptives. Family history of CV disease 24,3%, current smokers 18,2% and 42,3 had smoked. 61,2% were dislipidemic, 17,7 % were diabetics, 57 % were hypertensive. At the time of index admission the cardiovascular diagnosis were: history of AMI: 48,7 %, angina 52,1 %, heart failure 8,4 %, PTCA 23,1 %, CABG 18,4 %, arrhythmia 9,3 %, cerebrovascular event 5,7 %, peripherical vascular disease 7,0 %, valvular disease 2,6 %. The following are the values obtained at baseline: systolic BP 132,92+18,73 mmHg., diastolic BP 79,34_11,07 mmHg., total cholesterol 221,7+45,3 mg/dl, HDL cholesterol 44,77+11,36 mg/dl, LDL cholesterol 142,72+39,19 mg/dl, triglycerides 170,39+107,48 mg/dl, fasting glycemia 116,93+46,37 mg/dl, BMI 27,62+ 4,06 Kgm/m2. Body exercise: none 59,5 %, one time/week 8,2 %, two times/week 8,7 %, three times/week 20 % and on a rehabilitation programme 3,6 %.

Discussion:

Up to this moment the information about secondary prevention patients in Argentina was very little. The analysis of the HCNA population allows us to know which is the prevalence and severity of the modifiable risk factors. When looking at the data we must consider that although some of the patients enrolled were already receiving secondary prevention advice, they do not reach the standard goals, remaining as a very high cardiovascular risk population.

Conclusions:

In this population there is an important incidence of modifiable risk factors, which justify the implementation of secondary prevention progammes like the HCNA to optimise cardiovascular patients’ care.

 

Questions, contributions and commentaries to the Authors: send an e-mail message (up to 15 lines, without attachments) to epi-pcvc@pcvc.sminter.com.ar , written either in English, Spanish, or Portuguese.

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Bioengineering
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Update
Nov/13/1999