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.
- 1. Pearson TA, Peters TD. The treatment gap in coronary artery disease and heart failure: community standards and the post-discharge patient. Am J Cardiol 1997; 80(8B): 45H-52H.
- 2. Bowker TJ, Clayton TC, Ingham JE, et al. A British Cardiac Society survey of the potential for secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events). Heart 1996; 75: 334-342.
- 3. The EUROASPIRE Study Group. A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Eur Heart J 1997; 18: 1569-1582.
- 4. EUROASPIRE II Steering Group. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001; 357: 995-1001.
- 5. Pearson TA, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP). A multicenter survey to evaluate the percentages of dyslipidaemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000; 160: 459-467.
- 6. Vale MJ, Jelinek MV, Best JD, Santamaria JD. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the "real world". Randomized controlled trial. J Clin Epidemiol 2002; 55: 245-252.
- 7. Vale MJ, Jelinek MV, Best JD, et al, for the COACH study group, Melbourne, Victoria. Multicenter randomized controlled trial of coaching patients on achieving cardiovascular health (COACH); a proven method for achieving risk factor targets in patients with coronary heart disease [abstract]. Circulation 2001; 104 Suppl: II-391.
- 8. Ireland P, Jolley D, Giles G, et al. Development of the Melbourne FFQ: A food frequency questionnaire for use in an Australian prospective study involving an ethnically diverse cohort. Asia Pacific J Clin Nutr 1994; 3: 19-31.
- 9. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without the use of the preparative centrifuge. Clin Chem 1972; 18: 499-502.
- 10. Lipid management guidelines 2001. National Heart Foundation of Australia, The Cardiac Society of Australia and New Zealand. Med J Aust 2001; 175 (5 November Suppl.): S57-S85.
- 11. Guide for the use of lipid-lowering drugs in adults. Position statement prepared by the Nutrition and Metabolism Advisory Committee, National Heart Foundation of Australia. Melbourne: NHFA, 1998.
- 12. National Heart Foundation of Australia homepage. <http://www.heartfoundation.com.au>.
- 13. Zimmet P, Alberti G, de Courten MP. New classification and criteria for diabetes: moving the goalposts closer. Med J Aust 1998; 168: 593-594.
- 14. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical report series 854. Geneva: World Health Organization, 1995.
- 15. Stata statistical software [computer program]. Release 6.0. College Station, TX: Stata Corporation, 1999.
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