Patients with high cardiovascular risk in outpatient care in Slovakia: lessons from the NEMESYS and STAIRS studies
Authors:
J. Lietava 1; V. Kosmálová 1; J. Murín 2; D. Bartko Za Riešiteľov 3
Authors‘ workplace:
II. Interná klinika, Univerzitná nemocnica LF UK Bratislava, Slovenská republika
1; I. Interná klinika, Univerzitná nemocnica LF UK Bratislava, Slovenská republika
2; Ústredná univerzitná vojenská nemocnica Ružomberok, Slovenská republika
3
Published in:
Kardiol Rev Int Med 2011, 13(2): 109-116
Overview
The effective treatment of out-patients represents a basic strategy in the fight against cardiovascular disease and is precisely defined in numerous specialist guidelines, supported by evidence-based medicine. Its effectiveness is, however, rarely analysed in real-life medicine. The stratified
treatment of patients in primary preventative care is based on the SCORE system, which identifies high-risk patients, although so far only approximate estimates have been made of the numbers of high-risk patients in the care of first-instance doctors. Results: The proportion of high-risk patients being treated in outpatient care at general practitioners is relatively low – only 14%, with men showing higher prevalence of high, absolute risk (AR ≥ 5) compared to women: 25.0% vs. 6.8%, as well as a higher absolute risk compared to women: AR 2.96 vs. 1.38 (p < 0.001). The NEMESYS study documents the high prevalence of metabolic syndrome (MS) (48.7%) (IDF 2005). In agreement with data given in specialist literature, women show a higher prevalence compared to men (52.6% vs. 42.0%) (p < 0.001). AR is twice as high in those with MS compared to patients without MS (total: 2.70 vs. 1.36; men: 4.34 vs. 2.10; women: 1.94 vs. 0.84). AR in MS patients is higher in men compared to women (4.34 vs. 1.94). Monitoring levels of arterial hypertension were low, reaching figures of 36.5% in men and 38.0% in women. Treatment for hypertension does not take account of AR levels: patients with low, as well as high, AR received the same treatment and at inadequate levels. Patients with MS were more likely to receive treatment using all groups of antihypertensive drugs (OR 1.61–2.7) and used more medicines (2.13 vs. 1.86) than patients without MS, although the effectiveness of treatment was lower. Pharmacoeconomic analysis found equal annual costs for treatment of men and women (hypertension: 257 € vs. 263 €, MS 334 € vs. 321 € and diabetes mellitus 392 € vs. 384 €). Conclusion of NEMESYS study: It is theoretically possible, in outpatient care, to identify patients with a high absolute risk of ≥ 5 and it is pharmacoeconomically possible to provide them with the necessary treatment. The STAIRS study analysed the possibility of identifying heart failure in patients with arterial hypertension on the basis of clinical and anamnestic indicators of lowered tolerance to stress. Hypertonics with chronic heart failure showed a significantly lower tolerance for steps managed (18.8 vs. 29.2 steps; p = 0.001), but achieved a significantly greater improvement following short-term antihypertensive treatment (11.1 vs. 4.2 steps; p = 0.001). NYHA III patients tolerated less steps (13.8 ± 9.6 vs. 21.3 ± 13.3 steps; p = 0.001) and had lower stress tolerance (54.2 ± ± 25.0 vs. 42.0 ± 22.3; p = 0,001) than patients with NYHA II. Where patients tolerated 20 steps without dyspnoea as the crucial point for the identification of chronic heart failure, OR reached a value of 2.14 (1.50–3.06; p = 0.001). Sensitivity to tolerance of < 20 steps was low 0.42 (0.40–0.56) and specificity was appropriate 0.75 (0.73–0.76). Conclusion of STAIRS study: The methodologically undemanding anamnesis of dyspnoea during stress or the investigation of the number of tolerated steps can identify, to a satisfactory level of certainty, patients with suspected heart failure.
Keywords:
NEMESYS – STAIRS – metabolic syndrome – SCORE absolute risk – chronic heart failure – tolerance to exercise – NYHA
Sources
1. Kotseva K, Wood D, De Backer G et al. EUROAS--PIRE Study Group. Euroaspire III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16: 121–137.
2. Lietava J, Kosmálová V, Turek P et al za riešiteľov projektu Nemesys. Projekt Nemesys – skríning metabolického syndrómu u ambulantných pacientov. Interná Med 2006; 6: 685–689.
3. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – a new worldwide definition. Lancet 2005; 366: 1059–1062.
4. Conroy RM, Pyörälä K, Fitzgerald AP et al. SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Result of a risk estimation study in Europe. Eur Heart J 2003; 24: 987–1003.
5. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and Other Societes on Cardiovascular DiseasePrevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28: 2375–2414.
6. Mancia G, De Backer G, Dominzczak A et al. ESH-ESC Task Force on the Management of Arterial Hypertension. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force for the Management of Arterial. J Hypertens 2007; 25: 1105–1187.
7. Pracovná skupina pre manažment artériovej hypertenzie Európskej hypertenziologickej spoločnosti (EHS) a Európskej kardiologickej spoločnosti (ESC). Odporúčania pre manažment artériovej hypertenzie 2007. Cardiol 2008; 17 (Suppl 1): 2S–48S.
8. Dzúrik R, Trnovec T (eds). Štandardné terapeutické postupy. Martin: Osveta 2002.
9. Ardern CI, Janssen I. Metabolic syndrome and its association with morbidity and mortality. Appl Physiol Nutr Metab 2007; 32: 33–45.
10. Levine SA. Clinical Heart Disease. 3rd ed. Philadelphia: W. B. Saunders 1945.
11. Hunt SA, Abraham WT, Chin MH et al. 2009 forcused update into the ACC/AHA guidelines for the diagnosis and management of heart failure in adults: A reoprt of the American College of Cardiology Foundation/American Heart Association Task Force in Pracitical Guidelines: Developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119: e391–e479.
12. The Criteria Committee of the New York Heart Association. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis. 6th ed. Boston Mass: Little Brown 1928.
13. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston MA: Little Brown 1994.
14. Raphael C, Briscoe D, Davies J et al. Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart 2007; 93: 476–482.
15. Bennett JA, Riegel B, Bittner V et al. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart & Lung 2002; 31: 262–270.
16. Ingle L, Cleland JGF, Clark AL. Perception of symptoms is out of proportion to cardiac pathology in patients with „diastolic heart failure“. Heart 2008; 94: 748–753.
17. Miller-Davis C, Marden S, Leidy NC. The New York Heart Association Classes and functional status: What are we really measuring? Heart & Lung 2006; 35: 217–224.
Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
![Issue 2](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/0c43156700765818fc1097972c4df3a5.jpeg)
2011 Issue 2
Most read in this issue
- Prediction and prevention of atherosclerosis and personalized treatment of dyslipidemia
- Individualized therapy of arterial hypertension
- Prediction and prevention of diabetes mellitus type 2
- A case of atypical heart failure