Article

Despite the fact that subjects with established coronary heart
disease (CHD) are at high risk of further events and deserve meticulous secondary
prevention, current audits such as EUROASPIRE show poor control of major risk
factors. Ongoing monitoring is required. We present a new risk factor audit
system, SURF (Survey of Risk Factor management), that can be conducted much more
quickly and easily than existing audit systems and has the potential to allow
hospitals of all sizes to participate in a unified international audit system
that will complement EUROASPIRE. Initial experience indicates that SURF is truly
simple to undertake in an international setting, and this is illustrated with the
results of a substantive pilot project conducted in Europe and Asia. METHODS: The
data collection system was designed to allow rapid and easy data collection as
part of routine clinic work. Consecutive patients (aged 18 and over) with
established CHD attending outpatient cardiology clinics were included.
Information on demographics, previous coronary medical history, smoking history,
history of hypertension, dyslipidaemia or diabetes, physical activity, attendance
at cardiac rehabilitation, cardiac medications, lipid and glucose levels (and
HbA1c in diabetics) if available within the last year, blood pressure, heart
rate, body mass index, and waist circumference were collected using a one-page
data collection sheet. Years spent in full time education was added as an
additional question during the pilot phase. RESULTS: Three European countries -
Ireland (n = 251), Belgium (n = 122), and Croatia (n = 124) - and four Asian
countries - Singapore (n = 142), Taiwan (n = 334), India (n = 97), and Korea (n =
45) - were included in the pilot study. The results of initial field testing were
confirmed in that it proved possible to collect data within 60-90 seconds per
subject. There was poor control of several risk factors including high levels of
physical inactivity (41-45%), overweight and obesity (59-78%), and ongoing
smoking (15%). There were lower levels of individuals attending cardiac
rehabilitation in Asia. More Europeans than Asians reached the low-density
lipoprotein cholesterol target of <2.5mmol/l (66 vs. 59%) reflecting differences
in medication usage. However, blood pressure control was superior in Asia, with
71% <140/90 compared with 66% of Europeans (NS). CONCLUSIONS: This phase of SURF
has confirmed its ease of use which should allow wide participation and the
collection of representative risk factor data in subjects with CHD as well as
ongoing data collection to monitor secular trends in risk factor control.
Notwithstanding that this is a pilot study, the results suggest that risk factor
control, particularly for lifestyle-related measures, is poor in both Europe and
Asia.
CI - (c) The European Society of Cardiology 2012.

Langue : ANGLAIS