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How many patients with coronary heart disease are not achieving their risk-factor targets? Experience in Victoria 1996–1998 versus 1999–2000

Margarite J Vale, Michael V Jelinek and James D Best, on behalf of the COACH study group
Med J Aust 2002; 176 (5): 211-215.

Summary

Objectives: To determine the proportion of patients with established coronary heart disease (CHD) in two Australian studies (VIC-I in 1996–1998, and VIC-II in 1999–2000) who achieved their risk-factor targets as recommended by the National Heart Foundation of Australia, and to compare this proportion with those in studies from the United Kingdom (ASPIRE), Europe (EUROASPIRE I and II) and the United States (L-TAP).

Design and setting: Prospective cohort study with VIC-I set in a single Melbourne university teaching hospital and VIC-II set in six university teaching hospitals in Melbourne, Victoria.

Participants: 460 patients (112 in VIC-I, 348 in VIC-II) who completed follow-up in the control groups of two randomised controlled trials of a coaching intervention in patients with established CHD.

Main outcome measures: The treatment gap (100%, minus the percentage of patients achieving the target level for a particular modifiable risk factor) at six months after hospitalisation.

Results: The treatment gap declined from 96.4% (95% CI, 91%–99%) to 74.1% (95% CI, 69%–79%) for total cholesterol concentration (TC) < 4.0 mmol/L (P = 0.0001) and from 90.2% (95% CI, 83%–95%) to 54.0% (95% CI, 49%–59%) for TC < 4.5 mmol/L (P = 0.0001). This reduction in the treatment gap between VIC-I and VIC-II appears to be entirely explained by an increase in the number of patients prescribed lipid-lowering drugs. The treatment gaps in the UK and two European studies were substantially greater. The treatment gap for blood pressure (systolic 140 mmHg and/or diastolic 90 mmHg) in VIC-II was 39.5%, again less than corresponding European data. There were 8.1% of patients who had unrecognised diabetes in VIC-II (fasting glucose level 7 mmol/L), making a total of 25.6% of VIC-II patients with diabetes, self-reported or unrecognised. The proportion of patients in VIC-II who were obese (body mass index 30 kg/m2) was similar to the overseas studies, while fewer patients in VIC-II smoked compared with those in the UK and European studies.

Conclusions: A substantial treatment gap exists in Victorian patients with established CHD. The treatment gap compares well with international surveys and, at least in the lipid area, is diminishing.

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  • Margarite J Vale1
  • Michael V Jelinek2
  • James D Best3
  • on behalf of the COACH study group

  • 1 The COACH Study: Coaching patients on Achieving Cardiovascular Health.
  • 2 Department of Cardiology and the University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC.
  • 3 The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, VIC.

Correspondence: valemj@svhm.org.au

Acknowledgements: 

We gratefully acknowledge the invaluable assistance of Dr John Sanatamaria in creating the graphs for presenting our lipid data with international comparisons. This study was supported by an unconditional project grant from Merck Sharp and Dohme (Australia) Pty Limited and by a research program grant awarded by VicHealth (Victorian Health Promotion Foundation). The study sponsors had no part in the study design, data collection, data analysis, interpretation or in the writing of the manuscript. The dietary survey (VIC-II) was supported by a project grant from the Research and Grants Unit, St Vincent's Hospital Melbourne. This study was presented at the 49th Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand, Auckland, New Zealand, 5–8 August 2001.

Competing interests:

None declared.

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