Risk Factors in Patients Re-Admitted With ACS
Risk Factors in Patients Re-Admitted With ACS
An observational study was conducted on patients with pre-existing coronary heart disease who were re-admitted to an acute district general hospital with a further acute coronary event. Their demographics, admission drug therapies and cardiovascular risk factor parameters were recorded and analysed. Of the 100 patients admitted over a nine-month period, more than a quarter of them were taking suboptimal secondary prevention drug therapies. Furthermore, a proportion of patients were not achieving adequate cholesterol, blood pressure and heart rate targets, which, in turn, may be a major contributory factor for their re-presentation to hospital.
Over 90 people die from myocardial infarction (MI) every day in the UK. Cardiac rehabilitation, which incorporates cardioprotective drug therapies as one of its core components, has been shown to be associated with a reduction in recurrent MI. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set out a strategy in 2000 to change CHD services over the next 10 years. Improvements have been delivered in most standards of cardiac services but uptake and adherence to cardiac rehabilitation programmes following MI, coronary angioplasty or coronary artery bypass (CABG) surgery are still below the 85% target set for each of these diagnostic groups.
Studies have demonstrated prognostic benefits from effective management of cardiovascular (CV) risk factors in patients with established CHD. Clinical guidelines by the National Institute for Health and Clinical Excellence (NICE), American Heart Association (AHA)/American College of Cardiology (ACC) and European Society of Cardiology (ESC) emphasise risk factor modification through optimisation of drug therapies for secondary prevention following MI. All include treatment targets for blood pressure and lipid control, in addition to recommendations on diet, smoking cessation, physical activities and weight management. Failure of adherence to these guidelines could potentially increase the risk of recurrent coronary events and hospital re-admission rates. Although there is no guideline recommendation on post-MI heart rate target, elevated heart rate has been shown to be associated with increased risk of further cardiac events in those with established cardiovascular disease (CVD), and recent trials have shown benefits in patients with resting heart rate of <70 beats per minute and reduced left ventricular function.
Abstract and Introduction
Abstract
An observational study was conducted on patients with pre-existing coronary heart disease who were re-admitted to an acute district general hospital with a further acute coronary event. Their demographics, admission drug therapies and cardiovascular risk factor parameters were recorded and analysed. Of the 100 patients admitted over a nine-month period, more than a quarter of them were taking suboptimal secondary prevention drug therapies. Furthermore, a proportion of patients were not achieving adequate cholesterol, blood pressure and heart rate targets, which, in turn, may be a major contributory factor for their re-presentation to hospital.
Introduction
Over 90 people die from myocardial infarction (MI) every day in the UK. Cardiac rehabilitation, which incorporates cardioprotective drug therapies as one of its core components, has been shown to be associated with a reduction in recurrent MI. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set out a strategy in 2000 to change CHD services over the next 10 years. Improvements have been delivered in most standards of cardiac services but uptake and adherence to cardiac rehabilitation programmes following MI, coronary angioplasty or coronary artery bypass (CABG) surgery are still below the 85% target set for each of these diagnostic groups.
Studies have demonstrated prognostic benefits from effective management of cardiovascular (CV) risk factors in patients with established CHD. Clinical guidelines by the National Institute for Health and Clinical Excellence (NICE), American Heart Association (AHA)/American College of Cardiology (ACC) and European Society of Cardiology (ESC) emphasise risk factor modification through optimisation of drug therapies for secondary prevention following MI. All include treatment targets for blood pressure and lipid control, in addition to recommendations on diet, smoking cessation, physical activities and weight management. Failure of adherence to these guidelines could potentially increase the risk of recurrent coronary events and hospital re-admission rates. Although there is no guideline recommendation on post-MI heart rate target, elevated heart rate has been shown to be associated with increased risk of further cardiac events in those with established cardiovascular disease (CVD), and recent trials have shown benefits in patients with resting heart rate of <70 beats per minute and reduced left ventricular function.
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