SPC365

Beyond Guidelines: Achieving Risk Factors Therapeutic Goals through a Structured Follow-up Program

Session: Sessão de Posters 22 - Risco cardiovascular
Speaker: Marta Leite

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Marta Leite; Maksym Baburko; Eduardo Vilela; Sílvia O. Diaz; António Barros; Francisca Saraiva; Ricardo Fontes-Carvalho
<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px"><strong>Background: </strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">Patients with a history of acute coronary syndrome (ACS) face elevated risks of recurrent cardiovascular (CV) events. This study aims to evaluate the impact of a structured coronary disease follow-up program in achieving the guideline&#39;s&nbsp;recommended target goals for CV risk factors in secondary prevention.</span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px"><strong>Methods: </strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">In order to assess whether our follow-up program led to a greater number of patients with controlled CV risk factors, we defined&nbsp;two distinct patient cohorts: the Structured Coronary-Disease Cardiology Consultation (SCCC) group (237 patients, August 2021 to July 2022) and the control group&nbsp; - the&nbsp;Regular Cardiology Consultation (RCC) group (284 patients, January to December 2018).&nbsp;Over a 12-month observation period following the ACS event, parameters such as lipid profile, glycated hemoglobin (HbA1c) in diabetic patients, and systolic blood pressure (SBP) were collected in both groups.</span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">CV risk factors goals were defined in accordance with the recommended target values outlined in the most recent European Society of Cardiology (ESC) guidelines:&nbsp;<span style="color:#000000">LDL-C &lt;55 mg/dL (&lt;1.4 mmol/L) and an LDL-C reduction of &gt;50% from baseline, HbA1c&nbsp;&lt;7%, and BP &lt;140/90 mmHg.</span>&nbsp;Statistical analysis employed Chi-Square, Fisher&#39;s exact test, and Wilcoxon tests.</span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px"><strong>Results: </strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">SCCC group exhibited more patients with controlled LDL-C levels after 12 months of follow-up (16% RCC group&nbsp;vs. 41% SCCC group, p&lt;0.001)&nbsp;(Figure 1), and more than a half of the diabetic patients in the SCCC group achieved the therapeutic goal for HbA1c (35% RCC group vs. 59% SCCC group, p=0.02). Although no significant difference was observed in the number of patients considered &quot;on target&quot; for SBP (63% RCC group vs. 70% SCCC group, p=0.10), over two-thirds of patients in the SCCC group achieved the established goal.</span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">SCCC facilitated more intensive medication regimens, namely combination therapies. The combination of high-intensity statin and ezetimibe was used in 10.6% of patients in the RCC group and in 72.1% in the SCCC group. Among the diabetic patients, 28% of the RCC group were medicated with metformin monotherapy, and in comparison, in the SCCC group the percentage of patients medicated with monotherapy was low (0% metformin, 1.5% with insulin, 1.5% DPP4 inhibitors, 6.2% SGLT2 inhibitors). When considering only the most used antihypertensive medication, about 45.9% of patients in the RCC group and 43.8% the SCCC group were medicated with a combination of ACEI/ARA and BB.</span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px"><strong>Conclusions: </strong></span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">Implementing the SCCC program significantly increased the number of post-ACS patients with controlled CV risk factors. Standardized monitoring, extensive patient-physician interaction, early referrals, and specialized follow-up contributed to positive outcomes. </span></span></p>

<p style="text-align:justify"><span style="font-family:Verdana,Geneva,sans-serif"><span style="font-size:14px">This study advocates for adopting structured cardiology programs to optimize post-ACS patient care.</span></span></p>