Risk-factor control and secondary prevention in ischemic heart disease in primary care: real-world insights from
Johan-Emil Bager1,2, Georgios Mourtzinis1,3, Koen Simons4
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Secondary prevention in ischemic heart disease (IHD) shows low risk-factor control, especially LDL-C, and significant variation across primary health care centers (PHCCs). Control was lower in women than men, indicating a need for targeted strategies.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Current guidelines recommend stricter targets for blood pressure and LDL-cholesterol in ischemic heart disease (IHD) patients.
- Secondary prevention strategies may be insufficient and exhibit variability across patient groups and primary health care centers (PHCCs).
Purpose of the Study:
- To assess the heterogeneity of risk-factor control and secondary prevention in IHD patients within Swedish primary care.
- To evaluate the attainment of risk-factor control targets and the utilization of lipid-lowering and antithrombotic therapies.
Main Methods:
- A cross-sectional study utilized data from the QregPV Swedish regional primary-care register in September 2023.
- Evaluated risk-factor control (BP <140/90 mmHg, LDL-C <1.4 mmol/L, non-smoking) and therapy use (LLT, ATT) by age and sex.
- Multilevel models assessed heterogeneity among PHCCs, reported as adjusted median odds ratios (aMOR).
Main Results:
- 45,771 IHD patients were included; combined risk-factor control was low at 15.5%, primarily due to poor LDL-cholesterol (LDL-C) attainment (20.7%).
- Control decreased with age and was lower in women (aOR 0.60). Lipid-lowering therapy (LLT) and antithrombotic therapy (ATT) use was high (77.2% and 85.6%) but lower in women.
- Significant heterogeneity in control and therapy use was observed among PHCCs (aMOR 1.39).
Conclusions:
- Combined risk-factor control in IHD patients is suboptimal, largely driven by inadequate LDL-C management despite high LLT use.
- Significant variations in risk-factor control and therapy use exist between PHCCs and are more pronounced in women.
- Clinical strategies are needed to improve risk-factor control in both sexes and reduce inter-PHCC variability.
Aims:
With current, stricter lipid and blood pressure targets in patients with ischemic heart disease (IHD), secondary prevention may be insufficient and vary between patient groups and primary health care centres (PHCCs). We assessed the heterogeneity of risk-factor control and secondary prevention using contemporary Swedish primary-care data.
Methods:
Cross-sectional study of IHD patients in September 2023 from QregPV, a Swedish regional primary-care register. We evaluated the proportions attaining risk-factor control (blood pressure <140/90 mmHg, LDL-cholesterol [LDL-C] <1.4 mmol/L, and non-smoking) and the use of lipid-lowering therapy (LLT) and antithrombotic therapy (ATT) by age and sex using logistic regression models. Heterogeneity among PHCCs was estimated using multilevel models and summarised as adjusted median odds ratios (aMOR).
Results:
45 771 patients (34.5% women) were included. Combined risk-factor control was low, 15.5% (95% CI 15.0-16.0), mainly due to low LDL-C attainment, 20.7% (20.3-21.1). Combined risk-factor control decreased with higher age (p<0.001) and was lower in women than in men, age-adjusted odds ratio (aOR) 0.60 (0.55-0.66). LLT and ATT were used by 77.2% (76.8-77.6) and 85.6% (85.2-85.9), with lower usage in women, aOR 0.52 (0.50-0.54) and aOR 0.58 (0.54-0.62). Substantial heterogeneity among PHCCs was observed, with combined risk-factor control aMOR 1.39 (1.32-1.48).
Conclusion:
Combined risk-factor control was low, largely due to low LDL-C control, despite high LLT usage. Risk-factor control and the use of LLT and ATT varied between PHCCs and were lower in women than men. Concrete clinical strategies for attaining risk-factor goals in both sexes and for reducing PHCC variation are warranted.
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