Management and clinical outcome of stable coronary artery disease in Austria : Results from 5 years of the CLARIFY registry

Background The population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry. Methods CLARIFY was an international prospective observational registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization (CABG or PCI), coronary stenosis of more than 50% by coronary angiography or chest pain with myocardial ischemia. We analyzed demographic characteristics, risk factors, treatments and clinical outcomes of 424 Austrian outpatients with established CAD who were enrolled between November 2009 and July 2010 and observed until September 2015. Results The primary risk factors in Austrian outpatients with stable CAD were smoking (current smokers: 13.2%), overweight (77.1%), hypertension (78.5%), raised low-density lipoprotein (LDL) cholesterol plasma levels (81.4% 0.7 g/l or 1.8 mmol/l), elevated heart rate (70 bpm: 60.9% in patients with anginal symptoms) and poor physical activity (none or light activity: 63.4%). Patients received lipid-lowering drugs (predominantly statins), aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors according to current recommendations. After 5 years a systolic blood pressure (SBP) < 140 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg was reached in 58.5% of patients. Of the patients 70.4% had LDL cholesterol plasma levels below 1.0 g/l (2.6 mmol/l), 42.1% of smokers had stopped smoking, 42.9% of patients with anginal symptoms had a heart rate 60 bpm and 26.0% of diabetic patients had brought their HbA1c levels below 6.5%. Cardiovascular death, myocardial infarction or stroke occurred in 30 patients (7.1%), all-cause death in 25 cases (5.9%) and cardiovascular death in 15 cases (3.5%). Myocardial infarction was reported in 14 patients (fatal and non-fatal: 3.3%) and stroke in 8 patients (fatal and non-fatal: 1.9%), 39 patients (9.2%) underwent myocardial revascularization and 124 patients (29.2%) experienced cardiovascular hospitalization. Conclusion Characteristics of Austrian outpatients with stable CAD corresponded to those of patients with CAD in other developed countries. Medical treatments following the recommendations of the European guidelines were prescribed in the majority of patients; however, recommended goals of life style interventions including a heart rate less than 60 bpm and general risk factor management were not achieved by a high proportion of patients. Heart rate control and life style changes remain unmet needs of cardiovascular care in Austria.(VLID)357188

PLOS ONE / Clinical presentation and management of stable coronary artery disease in Austria

Background Cardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital. Methods The study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300. Results Female patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care. Conclusions Characteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent.(VLID)486957

Pulmonary haemodynamics during recovery from maximum incremental cycling exercise

Assessment of cardiac function during exercise can be technically demanding, making the recovery period a potentially attractive diagnostic window. However, the validity of this approach for exercise pulmonary haemodynamics has not been validated. The present study, therefore, evaluated directly measured pulmonary haemodynamics during 2-min recovery after maximum invasive cardiopulmonary exercise testing in patients evaluated for unexplained exertional intolerance. Based on peak exercise criteria, patients with exercise pulmonary hypertension (ePHn=36), exercise pulmonary venous hypertension (ePVHn=28) and age-matched controls (n=31) were analysed. By 2-min recovery, 83% (n=30) of ePH patients had a mean pulmonary artery pressure (mPAP) < 30 mmHg and 96% (n=27) of ePVH patients had a pulmonary arterial wedge pressure (PAWP) < 20 mmHg. Sensitivity of pulmonary hypertension-related haemodynamic measurements during recovery for ePH and ePVH diagnosis was <= 25%. In ePVH, pulmonary vascular compliance (PVC) returned to its resting value by 1-min recovery, while in ePH, elevated pulmonary vascular resistance (PVR) and decreased PVC persisted throughout recovery. In conclusion, we observed that mPAP and PAWP decay quickly during recovery in ePH and ePVH, compromising the sensitivity of recovery haemodynamic measurements in diagnosing pulmonary hypertension. ePH and ePVH had different PVR and PVC recovery patterns, suggesting differences in the underlying pulmonary hypertension pathophysiology.Sao Paulo Research Foundation (FAPESP)Brazilian National Council for Scientific and Technological Development (CNPq)Austrian Science Fund (FWF), Erwin SchroedingerNIHBrigham & Womens Hosp, Dept Med, Pulm & Crit Care Med, Clin 3,75 Francis St, Boston, MA 02115 USAHarvard Med Sch, Boston, MA USABrigham & Womens Hosp, Heart & Vasc Ctr, Boston, MA 02115 USAFed Univ Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, BrazilMed Univ Vienna, Dept Internal Med 2, Div Cardiol, Vienna, AustriaFed Univ Sao Paulo UNIFESP, Dept Med, Div Resp Dis, Sao Paulo, BrazilFAPESP: 2014/12212-5CNPq: 232643/2014-8Austrian Science Fund (FWF), Erwin Schroedinger: J3522-B13NIH: 2R01HL060234-12A1NIH: U01HL125215-01Web of Scienc

Characteristics of the ProCor II study population by gender.

<p>Characteristics of the ProCor II study population by gender.</p

Cardiovascular disease characteristics.

<p>Cardiovascular disease characteristics.</p

Regression estimates and confidence intervals of simple models analyzing predictors of heart rate in ProCor I (blue) and ProCor II (red).

<p>The effect of age is shown in HR change per 10 years. Female denotes female gender.</p

Ischemic heart disease medications.

<p>Ischemic heart disease medications.</p

Regression estimates and confidence intervals resulting from multiple imputations and variable selections applied to the pooled data from ProCor I and ProCor II.

<p>Female denotes female gender.</p

Regression estimates and confidence intervals of simple models analyzing predictors of heart rate using variables that were unique to the ProCor II dataset.

<p>Regression estimates and confidence intervals of simple models analyzing predictors of heart rate using variables that were unique to the ProCor II dataset.</p