EUROASPIRE European surveys of CVD prevention and diabetes Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London UK
EUROASPIRE SURVEYS European Action on Secondary and Primary Prevention of Cardiovascular Disease In Order to Reduce Events European Society of Cardiology EuroObsevational Research Programme
EUROASPIRE surveys Methodology Cross sectional surveys Retrospective identification of consecutive patients Interview and examination using standardised instruments including a central laboratory for lipids and glucose
EUROASPIRE I, II and III
Finland Netherlands
Slovenia
Germany
Czech Republic France
Italy
Hungary
K Kotseva, et al Lancet 2009; 373; 929-940
EUROASPIRE surveys
Time trends
Prevalence of smoking, obesity* and central obesity** *Body mass index ≥ 30 kg/m² **Waist circumference ≥ 88 cm for women and ≥ 102 cm for men 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Smoking
Obesity
Central obesity
Survey 1
20.3%
25.0%
42.2%
Survey 2
21.2%
32.6%
53.0%
Survey 3
18.2%
38.0%
54.9%
in Prevalence prevalence smoking in and gender EUROASPIRETrends I, II and III: of of smoking by age EUROASPIRE I, II and III surveys
Prevalence of raised blood pressure*, elevated TC** and LDL-C***, and self-reported diabetes mellitus *SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg diabetics ** TC ≥4.5 mmol/l; *** LDL-C ≥4.5 mmol/l 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Raised BP
Elevated TC
Elevated LDL-C
Diabetes
Survey 1
58.1%
94.5%
96.4%
17.4%
Survey 2
58.3%
76.7%
78.1%
20.1%
Survey 3
60.9%
46.2%
47.5%
28.0%
Cardiovascular Protective Drug Therapies
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Antiplatelets
Beta-blockers
ACE/ARB's
Statins
Survey 1
80.8%
56.0%
31.0%
18.1%
Survey 2
83.6%
69.0%
49.2%
57.3%
Survey 3
93.2%
85.5%
74.5%
87.0%
EUROASPIRE III Hospital 8966 coronary patients from 22 countries
Netherlands
Finland Russia
Ireland Latvia
UK
Lithuania
Germany Czech Republic France Croatia
Poland Hungary
Belgium Slovenia
Romania Bulgaria Greece
Spain Italy
Turkey Cyprus
K Kotseva Eur J Cardiovasc Prev Rehab 2009; 16:121-37
EUROASPIRE III Study Populations
Coronary patients in hospital: •CABG/PTCA; •ACS (STEMI/NSTEMI); •Myocardial ischaemia
EUROASPIRE surveys
Audit of medical record keeping
Available information in medical records: Risk factor levels
EuroASPIRE
Medical records
100%
Admission
Discharge 92% 87%
90% 80% 70%
66% 62%
63%
63%
Systolic BP
Heart rate
60% 50% 41%
40%
40% 30% 20%
14%
13%
10% 0% Height
Weight
Waist circumference
EuroASPIRE
Available information in medical records: Risk factor levels Medical records
100%
Admission
Discharge
90% 80%
80% 75% 67%
70% 60%
54%
57%
58%
56% 48%
50% 41%
41%
40% 30% 20%
15%
10%
11%
6% 4%
0% TC
HDL
Triglycerides
LDL
Glucose
HbA1c
HbA1c in diabetics
EUROASPIRE surveys
Assessment of patient management through standardised interviews and examinations
Advise to follow cardiac prevention or rehabilitation programme*
EuroASPIRE III
Interview
90.3%
Lithuania Ireland Belgium
88.0% 77.8% 71.3%
Bulgaria Slovenia Germany Hungary The Netherlands
60.5% 57.8% 56.6% 54.6% 53.4%
Poland Italy Czech Republic United Kingdom Croatia Finland
51.5% 50.0% 43.0% 41.9% 40.2% 37.7%
Latvia France Romania Russian Federation Turkey
32.4% 26.4%
All patients: 44.9%
8.2%
MOR = 5.46 Men 45.9% , Women 42.0%
7.3%
4.9% Cyprus Greece 0.8% Spain 0.6% 0%
10%
20%
30%
40%
50%
* Within 3 months of discharge following the index event or procedure
60%
70%
80%
90%
100%
Proportion of patients advised to follow a CRP by diagnotic category
100 90 80
75
70
%
60 50
40
40
41 30
30 20 10 0
CABG
PTCA
AMI
Ischaemia
Prevalence of CVD risk factors according to participation in a CRP 70
50
%
57
54 47
40 30
p=0.14
P=0.0008
60
p<0.0001
p=0.004 No CRP
56 49
p=0.83 35
CRP
53
35
20 10
15
19
0 Smoking
Smoking*
Obesity
Raised BP**
Elevated TC***
•*Among patients smoking prior to the index event • **BP ≥ 140/90 mmHg, (≥ 130/80 mmHg in patients with diabetes);*** TC ≥ 4.5 mmol/L
EUROASPIRE III PRIMARY CARE 4366 high risk patients from 12 countries Finland Netherlands
Slovenia
Germany
Czech Republic France
Italy
Hungary
K Kotseva Eur J Cardiovasc Prev Rehab 2010; 16:121-37
EUROASPIRE III Study Populations
Individuals at high risk of developing cardiovascular disease in primary care: •Hypertension •Dyslipidaemia •Diabetes
EUROASPIRE surveys
Patient attitudes, knowledge and skills
EuroASPIRE III
â&#x20AC;&#x153;Are you worried that you may develop heart disease?â&#x20AC;? Interview
Germany
46
Belgium
8 55
UK
8
46
24
79
Italy
11
59
Poland 58
Finland
58
Romania
10 14
8
34
8
35
7
79
16
21
5
75
Spain
5
76
Latvia
21
78 10%
11
31 78
Slovenia
0%
37 30
Croatia
Bulgaria
47
20%
30%
40%
Agree All patients:
63.2%
3 21
50%
Neutral 26.1%
60%
70%
Disagree 10.7%
80%
90%
1 100%
â&#x20AC;&#x153;What you think your risk of heart disease is in next 10 years?â&#x20AC;?
EuroASPIRE III
Interview
Finland
16
38
Latvia 1
51
Croatia
49
30
23
Germany
49
18
Spain
25
41
24
28
UK
46
16
Romania
23
41
23
19
Poland
25
47
20
Belgium
49
11
22
58
6
20
49
Italy 0%
37
12
Slovenia
Bulgaria
44
14
28 10%
39 20%
30%
Low All patients:
16.4%
40%
Moderate 45.6%
12 50%
60%
70%
High
Don't know
24.8%
13.2%
80%
90%
100%
EuroASPIRE III
â&#x20AC;&#x153;Do you think your risk is higher, lower, or about the same as a person of the same age and sex as you?â&#x20AC;? Interview
Italy 1
39
Finland Latvia
20
Germany
13
37
52
10
36
55
12
35 54
18
Poland
17
Slovenia
34 50
33
53
30
33
41
14
27
66
Bulgaria 0%
46 50
UK
Romania
50
45 13
Spain
30
9
Croatia
Belgium
61
21
52 10%
20%
33 30%
40%
Lower All patients:
16.2%
50%
Same 46.8%
60%
70%
Higher 36.9%
15 80%
90%
100%
EUROASPIRE surveys
Comparisons of secondary and primary prevention
EUROASPIRE III A comparison of coronary and high risk patients 100%
* WC < 94 cm (men); < 84 cm (women)
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Smoking
BMI > 30 kg/m2
Abdo obesity*
Coronary
46.5%
35.5%
52.0%
High Risk
83.6%
43.5%
61.6%
Column 3
EUROASPIRE III A comparison of coronary and high risk patients **SBP/DBP ≥ 140/90 mmHg for non-diabetics or ≥ 130/80 mmHg for diabetes ****Self-reported and/or glucose ≥ 7.0 mmol/l; **** in patients with self reported diabetes 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
BP>140/90mmHg**
TC>4.5 mmol/l
LDL-C>2.5 mmol/l
Diabetes***
Glucose >6.1mmol/l
Coronary
54.0%
44.0%
44%
25%
90%
High risk
71.0%
79.0%
81%
43%
91%
Column 3
EUROASPIRE III A comparison of coronary and high risk patients
Cardioprotective drug therapies 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Anti-platelets
B-blockers
ACE/ARB's
Ca antagonists
Statins
Coronary
90.5%
79.8%
71%
25%
78%
High risk
22.0%
31.1%
56%
24%
40%
Column 3
EUROASPIRE surveys
Health economics
EUROASPIRE surveys
Health economics
EUROASPIRE surveys
Prevention is cost effective!
EUROASPIRE surveys
Prevention is cost effective but it deprives us of business!
National Coordinators Giovanni Ambrosio Philippe Amouyel Steering Committee Dennis Cokkinos (3) Guy De Backer Jaap Deckers II. National Coordinators Vilnis Dzerve Zlatko Fras Dan Gaita Nina Gotcheva Ian Graham Ulrich Keil
Aleksandras Laucevicius Seppo Lehto Pambis Nicolaides Rafael Oganov Erika Ostör Andrzej Pajak Zeljko Reiner Jaroslav Simon Lâle Tokgözoğlu Jose De Velasco Kornelia Kotseva