Current standard of care in patients affected by coronary heart disease in Italy: The MC'95 study

Background. The aims of MC'95 were to verify i) whether the main risk factors for coronary heart disease had been recorded in the hospital medical records of patients admitted for coronary events; ii) how modifiable risk factors had been managed by drug therapy and lifestyle advices following hospitalization; iii) whether first-degree blood relatives of patients had been screened for coronary heart disease risk factors. Methods. The survey concerned 40 hospital units across Italy admitting patients with acute coronary events or offering interventional cardiology or cardiac surgery. Two thousand and four hospital records (50 for each unit) of consecutive patients (≤ 74 years, 21% women) discharged within 6 months before initiation of the study (November 1995) were reviewed and the patients were invited for a follow-up examination from 6 to 9 months after hospital discharge. Results. The prevalence of patients positive for risk factors reported was: 58.5% for high total cholesterol (≥ 5.2 mmol/l), 46.9% for high blood pressure (≥ 140/90 mmHg), 35.2% for smoking, 20.2% for high blood glucose (> 7 mmol/l), and 14.2% for obesity (body mass index ≥ 30 kg/m 2). A number of medical records did not provide complete information on risk factors: 24.1% for body mass index, 11.0% for serum cholesterol, and 11.6% for a family history of premature coronary heart disease. Eighty-nine percent of the patients attended the follow-up examination. Their care during the follow-up period was managed by general practitioners (30.5%), cardiologists (37.2%) and/or at hospital outpatient clinics (42.4%). At follow-up examination the prevalence of hypercholesterolemia increased to 62.2%, that of uncontrolled hypertension decreased to 32.2%, and the percentage of smokers decreased to 13.6%. The adherence to the drug treatment prescribed at discharge was as follows: 69.6% for lipid-lowering agents, 81.2% for ACE-inhibitors and beta-blockers, and 90.8% for antiplatelet agents. A family history of premature heart disease was reported in 55.1% of patients but screening for coronary heart disease risk factors was extended to relatives in less than 25% of cases. Conclusions. The prevalence of modifiable risk factors is high in patients with different clinical manifestations of coronary heart disease. The prescriptions for secondary prevention and their efficacy after hospital discharge and the surveying of relatives for primary prevention need to be improved. For this purpose, a more coordinated intervention of primary care physicians, cardiologists and cardiac surgeons is mandatory.