Poor long-term cardiovascular risk factor management after acute coronary syndrome: An observational cohort study
Jessica Schubert1, Maria K Svensson1,2, Margret Leosdottir3,4
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Long-term management after acute coronary syndrome (ACS) shows significant gaps in monitoring cardiovascular risk factors like LDL-C and SBP. Women and those without structured follow-up experienced poorer risk factor control, indicating missed secondary prevention opportunities.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular risk factor control is crucial for secondary prevention after acute coronary syndrome (ACS).
- Long-term management strategies and outcomes following ACS are not well-documented.
- Effective post-ACS care requires continuous monitoring of key risk factors.
Purpose of the Study:
- To evaluate the frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring.
- To assess target achievement for LDL-C and SBP up to three years post-ACS.
- To identify factors associated with monitoring and target achievement in the long-term post-ACS period.
Main Methods:
- Retrospective analysis of electronic health records (EHRs) for patients hospitalized with ACS (2012-2020).
- Utilized adjusted regression models to estimate measurement probability and target achievement.
- Examined associations with sex, cardiac rehabilitation (CR) participation, diabetes management, and diagnostic coding.
Main Results:
- Follow-up data were available for a declining proportion of patients over three years (72% year 1, 44% year 3).
- Significant proportions lacked LDL-C (48%) and SBP (16%) measurements by year 3.
- Female sex was linked to lower monitoring and poorer risk factor control; CR and structured follow-up improved monitoring.
Conclusions:
- Substantial gaps in risk factor monitoring and achievement highlight missed opportunities for secondary prevention post-ACS.
- Female patients and those lacking structured follow-up or diagnostic codes experienced less frequent monitoring and suboptimal risk factor control.
- Improved adherence to guidelines for long-term risk factor management is essential for reducing recurrent cardiovascular events.
Background:
Cardiovascular risk factor control reduces the risk of recurrent events after acute coronary syndrome (ACS). Long-term post-ACS management is poorly studied.
Objectives:
To assess frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post-ACS.
Methods:
Data from all patients hospitalized for ACS in Uppsala between 2012 and 2020 were obtained from electronic health records (EHRs). The probability of measurement and target achievement was estimated with adjusted regression models. Associations were assessed for sex, participation in cardiac rehabilitation (CR), presence of diabetes with nurse-led follow-up and documentation of an ICD-10 code for chronic ischaemic heart disease in the EHR.
Results:
Among 6083 patients (median age 73 years, 34% female), follow-up data were available for 72% in year 1, 56% in year 2 and 44% in year 3. Year 3 LDL-C was not measured in 48% of patients, and 19% were at target (<1.8 mmol/L). For SBP, 16% lacked a measurement, and 50% were at target (<140 mmHg). Female sex was associated with lower probability of having LDL-C measured or having LDL-C or SBP at target. CR participation, structured diabetes follow-up or having a chronic ischaemic heart disease code in the EHR was associated with a higher probability of LDL-C and SBP measurements at 2 and 3 years.
Conclusions:
Lack of measurement and low risk factor achievement highlight missed opportunities in secondary prevention. Female sex, lack of structured follow-up and the absence of diagnostic labelling were associated with less frequent monitoring and poorer risk factor control.
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