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[Do our patients follow the clinical indications prescribed after coronary angiography?]
M Bobbio1, V Riccardi, S Bongioanni
1Cattedra di Cardiologia, Università di Torino.
Insights
Patient treatment adherence after coronary angiography is generally good. Non-compliance with recommended therapies like percutaneous transluminal coronary angioplasty or coronary artery bypass grafting is uncommon and often due to patient preference or changing health conditions.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Outcomes Research
Background:
- Assessing patient adherence to medical advice post-coronary angiography is crucial for effective treatment.
- Understanding factors influencing compliance is key to improving cardiovascular care outcomes.
Purpose of the Study:
- To evaluate patient compliance with recommended treatments following coronary angiography.
- To identify clinical predictors associated with non-compliance to therapies such as medical management, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG).
Main Methods:
- A cohort of 392 patients who underwent coronary angiography in 1990 was analyzed.
- Patients were assessed one year post-procedure to determine adherence to recommended treatments: medical therapy, PTCA, or CABG.
- Statistical analysis, including stepwise discriminant regression, was used to identify predictors of non-compliance.
Main Results:
- Non-compliance rates were 11% for medical therapy, 6% for PTCA, and 13% for CABG.
- Predictors of non-compliance for medical therapy included older age, congestive heart failure, and critical left anterior descending artery lesions.
- Absence of typical angina predicted non-compliance for CABG recommendations. Patient preference and clinical deterioration were common reasons for non-adherence.
Conclusions:
- Non-compliance with recommended treatments after coronary angiography is infrequent.
- Patient preference for less invasive options and shifts in clinical status are primary drivers of non-adherence.
- Non-compliance did not significantly impact one-year mortality rates.
Background:
Aim of the study is to evaluate patients compliance with therapeutic recommendations after coronary angiography.
Methods:
We analyzed all patients who underwent coronary angiography in an university center during 1990. One of the following treatments were recommended: medical therapy without revascularization, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting. A cohort of 392 patients was assessed one year after coronary angiography in order to evaluate clinical predictors of non compliance with the treatment recommended.
Results:
Of the 141 patients, for whom medical treatment was recommended, 16 (11%: 95% confidence interval 6-17%) had revascularization. By stepwise discriminant regression analysis, older age, congestive heart failure and critical lesion of the left anterior descending artery were statistically significant predictors of non compliance. Of the 137 patients, for whom PTCA was recommended, 8 (6%: 2-9%) were non compliant. No variables were predictive of non compliance. Of the 114 patients, for whom CABG was recommended, 15 (13%: 7-19%) were non compliant. By stepwise regression analysis, absence of typical angina was predictive of non compliance. For 12 patients non compliance was related to personal preferences, for 10 to clinical deterioration, for 9 to a second opinion, and 3 were still in the surgical waiting list one year after coronary angiography. One year mortality was not affected by non compliance.
Conclusions:
Non compliance to recommended treatment after coronary angiography is uncommon and is mainly related to patients preference towards a less invasive treatment or to a change of clinical conditions over time.