A comprehensive secondary prevention benchmark (2PBM) score identifying differences in secondary prevention care in patients after acute coronary syndrome. (11th May 2021)

• Record Type: Journal Article
• Authors: Liu, Y; Haegele, M; Frey, S; Strebel, I; Jordan, F; Lange, R; Burkard, T; Clerc, OF; Pfister, O
• Is Part Of: European journal of preventive cardiology. Volume 28:Supplement 1(2021)
• Publication Date: 2021-05-11
• Subjects: Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1093/eurjpc/zwab061.270
• Languages: English
• ISSNs: 2047-4873

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grands from AstraZeneca, Boehringer Ingelheim and Sanofi Background: Reaching secondary prevention targets improves long-term prognosis in patients after acute coronary syndrome (ACS). Although prevention targets are defined by guidelines, their achievement rates are insufficiently documented. Suitable benchmarking tools are lacking. Purpose: We aimed to determine the degree of secondary prevention care by creating a secondary prevention benchmark score (2PBM) and using it in patients undergoing ambulatory cardiac rehabilitation (CR) after an acute coronary syndrome. Methods: In this observational cohort study, 472 consecutive ACS patients who completed the local ambulatory CR programme between 2017-2019 were included. Benchmarks for secondary prevention medication, clinical and lifestyle targets were predefined and combined in the complete 2PBM with maximum 10 points. The association of patient characteristics and achievement rates of individual components and the complete 2PBM were assessed using multivariable logistic regression analysis. Results: Patients were on average 62 ± 11 years old and predominantly male (n = 406; 86%). Type of ACS was ST-elevation myocardial infarction (STEMI) in 241 patients (51%) and non-ST-elevation myocardial infarction in 216 patients (46%). Achievement rates for individual components of the 2PBM were 71% for medication, 35% for clinical and 61% for lifestyle benchmarks. Achievement of medication benchmark was associated with younger age [odds ratio (OR): 0.979, 95% confidence interval (CI) 0.959-0.996, p = 0.021] and history of STEMI [OR: 2.05, 95% CI 1.35-3.12, p = 0.001]. Achievement of clinical benchmark was associated with medication benchmark [OR: 1.66, 95% CI 1.03-2.71, p = 0.042]. The complete 2PBM was achieved by 74 patients (16%), while 362 patients (77%) reached ≥8 points. Achievement of complete 2PBM was independently associated with a history of STEMI [OR: 1.79, 95 CI 1.06-3.08 p = 0.032]. Conclusion: Benchmarking with 2PBM identifies gaps and achievements in secondary prevention care. A history of STEMI was associated with the highest 2PBM score, suggesting best secondary prevention care in patients after STEMI. 2PBM may be used for internal quality control, comparison of cohorts and future correlation studies between CR targets and outcomes.