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Healthcare delivery, economics and global health
Determinants of coronary artery disease risk factor management across three world regions
  1. Min Zhao1,
  2. Ian Graham2,
  3. Marie Therese Cooney3,4,
  4. Diederick E Grobbee1,5,
  5. Ilonca Vaartjes6,
  6. Kerstin Klipstein-Grobusch1,7
  1. 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  2. 2 Trinity College Dublin, Dublin, Ireland
  3. 3 St Vincent’s University Hospital, Dublin, Ireland
  4. 4 University College Dublin, Dublin, Ireland
  5. 5 Global Geo Health Data Center, Utrecht University, Utrecht, The Netherlands
  6. 6 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, Utrecht, The Netherlands
  7. 7 Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Min Zhao, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508, The Netherlands; m.zhao{at}umcutrecht.nl

Abstract

Background The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.

Methods and results SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.

Conclusions Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.

  • coronary heart disease
  • risk factors
  • determinants
  • SURF
  • secondary prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/heartasia-2018-011112

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    Footnotes

    • Contributors MZ, IG, KK-G and IV conceived and designed the study. MZ analysed and interpreted the data. MZ drafted the manuscript, and all authors contributed to critical revision of the manuscript.

    • Funding MZ is supported by a grant from the Netherlands Organization for Scientific Research (NWO; grant number: 0.22.005.021). NWO had no input to the design, execution, analysis or writing up of the study. IV is supported by a grant from the Dutch Heart Foundation (grant DHF project 'Facts and Figures').

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.