EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.

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Abstract

To determine whether the Joint European Societies guidelines on cardiovascular prevention are being followed in everyday clinical practice of secondary prevention and to describe the lifestyle, risk factor and therapeutic management of coronary patients across Europe.

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Most cited references 27

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A meta-analysis of the association between adherence to drug therapy and mortality.

Scot H Simpson, Dean T. Eurich, Sumit Majumdar … (2006)

To evaluate the relation between adherence to drug therapy, including placebo, and mortality. Meta-analysis of observational studies. Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality. Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11). Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.

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Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction.

Jeppe Rasmussen, Alice Chong, David Alter (2007)

The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to "healthy adherer" behavioral attributes more so than to pharmacological benefits. To explore the relationship between drug adherence and mortality in survivors of acute myocardial infarction (AMI). Population-based, observational, longitudinal study of 31 455 elderly AMI survivors between 1999 and 2003 in Ontario. All patients filled a prescription for statins, beta-blockers, or calcium channel blockers, with the latter drug considered a control given the absence of clinical trial-proven survival benefits. Patient adherence was subdivided a priori into 3 categories--high (proportion of days covered, > or =80%), intermediate (proportion of days covered, 40%-79%), and low (proportion of days covered, <40%)--and compared with long-term mortality (median of 2.4 years of follow-up) using multivariable survival models (and propensity analyses) adjusted for sociodemographic factors, illness severity, comorbidities, and concomitant use of evidence-based therapies. Among statin users, compared with their high-adherence counterparts, the risk of mortality was greatest for low adherers (deaths in 261/1071 (24%) vs 2310/14,345 (16%); adjusted hazard ratio, 1.25; 95% confidence interval, 1.09-1.42; P = .001) and was intermediary for intermediate adherers (deaths in 472/2407 (20%); adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .03). A similar but less pronounced dose-response-type adherence-mortality association was observed for beta-blockers. Mortality was not associated with adherence to calcium channel blockers. Moreover, sensitivity analyses demonstrated no relationships between drug adherence and cancer-related admissions, outcomes for which biological plausibility do not exist. The long-term survival advantages associated with improved drug adherence after AMI appear to be class-specific, suggesting that adherence outcome benefits are mediated by drug effects and do not merely reflect an epiphenomenon of "healthy adherer" behavioral attributes.

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Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.

Julia A Critchley, Simon Capewell (2003)

As more interventions become available for the treatment of coronary heart disease (CHD), policy makers and health practitioners need to understand the benefits of each intervention, to better determine where to focus resources. This is particularly true when a patient with CHD quits smoking. To conduct a systematic review to determine the magnitude of risk reduction achieved by smoking cessation in patients with CHD. Nine electronic databases were searched from start of database to April 2003, supplemented by cross-checking references, contact with experts, and with large international cohort studies (identified by the Prospective Studies Collaboration). Prospective cohort studies of patients who were diagnosed with CHD were included if they reported all-cause mortality and had at least 2 years of follow-up. Smoking status had to be measured after CHD diagnosis to ascertain quitting. Two reviewers independently assessed studies to determine eligibility, quality assessment of studies, and results, and independently carried out data extraction using a prepiloted, standardized form. From the literature search, 665 publications were screened and 20 studies were included. Results showed a 36% reduction in crude relative risk (RR) of mortality for patients with CHD who quit compared with those who continued smoking (RR, 0.64; 95% confidence interval [CI], 0.58-0.71). Results from individual studies did not vary greatly despite many differences in patient characteristics, such as age, sex, type of CHD, and the years in which studies took place. Adjusted risk estimates did not differ substantially from crude estimates. Many studies did not adequately address quality issues, such as control of confounding, and misclassification of smoking status. However, restriction to 6 higher-quality studies had little effect on the estimate (RR, 0.71; 95% CI, 0.65-0.77). Few studies included large numbers of elderly persons, women, ethnic minorities, or patients from developing countries. Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD. This risk reduction appears to be consistent regardless of age, sex, index cardiac event, country, and year of study commencement.

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Author and article information

Journal

Journal ID (iso-abbrev): Eur J Prev Cardiol

Title: European journal of preventive cardiology

ISSN (Electronic): 2047-4881

ISSN (Print): 2047-4873

Publication date (Electronic): Apr 2016

Volume: 23

Issue: 6

Affiliations

[1 ] The European Society of Cardiology, Sophia Antipolis Cedex, France International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK k.kotseva@imperial.ac.uk.

[2 ] The European Society of Cardiology, Sophia Antipolis Cedex, France International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK.

[3 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Department of Public Health, University of Ghent, Belgium.

[4 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

[5 ] Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

[6 ] Institut Pasteur de Lille, Université de Lille, France.

[7 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Centre for Cardiovascular Prevention, 1st Medical Faculty Charles University and Thomayer Hospital, Prague, Czech Republic.

[8 ] Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.

[9 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Thoraxcentre's Department of Cardiology, Rotterdam, The Netherlands.

[10 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Department of Internal Medicine, University of Ghent, Belgium.

[11 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Clinical Centre University of Sarajevo, Bosnia and Herzegovina.

[12 ] Department of Cardiology, Shupyk's National Medical Academy of Postgraduate Education, Kiev, Ukraine.

[13 ] The European Society of Cardiology, Sophia Antipolis Cedex, France University of Latvia, Pauls Stradins Clinical University Hospital, Riga, Latvia.

[14 ] The European Society of Cardiology, Sophia Antipolis Cedex, France University Medical Centre, Ljubljana, Slovenia.

[15 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Universitatea de Medicina si Farmacie 'Victor Babes', Institutul de Boli Cardiovasculare, Timisoara, Romania.

[16 ] Department of Cardiology, National Heart Hospital, Sofia, Bulgaria.

[17 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Cardiology Department of Medical School University of Ioannina, Greece.

[18 ] Institute of Clinical Epidemiology and Biometry, University of Würzburg; Comprehensive Heart Failure Centre, University of Würzburg; Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany.

[19 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Clinic of Cardiovascular Diseases of Vilnius University; Heart and Vascular Medicine of Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania.

[20 ] Kuopio University Hospital, Finland.

[21 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Clinic for Internal Medicine Intermedica, Nis, Serbia.

[22 ] The European Society of Cardiology, Sophia Antipolis Cedex, France University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia.

[23 ] The Adelaide and Meath Hospital, Dublin, Ireland.

[24 ] The European Society of Cardiology, Sophia Antipolis Cedex, France University of Nicosia Medical School, Nicosia General Hospital, Cyprus.

[25 ] National Research Centre for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.

[26 ] Jagiellonian University Medical College, Faculty of Health Sciences, Department of Epidemiology and Population Studies, Kracow, Poland.

[27 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention, National Research Centre for Preventive Medicine, Moscow, Russia.

[28 ] The European Society of Cardiology, Sophia Antipolis Cedex, France University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.

[29 ] Department of Heart Failure and Valve Disease, Skåne University Hospital, Lund, Sweden.

[30 ] Comprehensive Heart Failure Centre and Department of Medicine I, University of Würzburg, Germany.

[31 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Hacettepe University, Ankara, Turkey.

[32 ] The European Society of Cardiology, Sophia Antipolis Cedex, France Centre for Medical Research, School of Medicine, University of Banja Luka, Bosnia and Herzegovina.