Cardiovascular Risk Factors Management Survey In Patients Of Hospitalization With Coronary Heart Disease

Objective: Hypertension, hyperlipidemia, diabetes are risk factors for CHD has been confirmed. In order to better guide clinical treatment, in recent years, domestic and overseas committee of experts develop various evidence-based guidelines for clinicians a more rational management of cardiovascular risk factors specified in the right direction. Clinical practice has been confirmed ,to reduce the incidence of CHD and mortality, lower readmission rate,we must follow guidelines in the diagnosis and treatment of CHD. Many patients are readmission, to strengthen the control of risk factors for CHD and intervention,emphasis on secondary prevention of CHD , to reduce cardiovascular clinical events, it is particularly important. Whether the management and treatment are in the place need to be research.The purpose of this study is through a large sample of multi-center clinical investigation inpatients with coronary heart disease in recent years to acquaint us with blood pressure, blood lipid , blood glucose and clinical intervention efforts, knowing about blood pressure and lipid control in patients with CHD and the gap between clinical treatment and guidelines, to improve clinicians management of risk factors for coronary heart disease awareness, strengthen secondary prevention of CHD, reduce rehospitalization rates in patients with CHD and the occurrence of cardiovascular adverse events.Methods: From Hebei, Shanxi and Tianjin,randomly selecting patients with CHD that condition improves and leaving hospital safly from ten hospitals of three A-level during year of 2003,2005 and2008, a total of 2351 patients, divided into three groups according to year of hospitalization. Statistics the total number of each group, age, gender, admission and discharge of blood pressure, blood lipids, the number of patients with stable angina (SA), acute coronary syndrome (ACS), hypertension and diabetes (including the newly diagnosed diabetic people) and the number of patients determing blood glucose,using antihypertensive,lipid-lowering drugs and anti-platelet drugs .In each group the number of patients with blood pressure and blood lipids (LDL-C) attainment when discharged from hospital. Analysising rate of the prevalence of hypertension, compliance rate of blood pressure of admission and discharge, compliance rate of lipid, intervention rate of blood pressure and lipid lowering drugs, rate of prevalence of diabetes in each group, determination rate of the fasting, postprandial 2h blood glucose and OGTT , in order to compare the rate of each group whether there were significant differences.Statistical analysis: Measurements data using the mean value±standard deviation were tested for normality and homogeneity of variance test. The statistical method between the two groups compares used T-test; Count data expressed in percentage terms between the two groups applied chi-square test, P<0.05 has significance for difference. All statistical analysis were done on SPSS13.0 software.Results: 2003,2005,2008-year prevalence rates of hypertension in inpatient with CHD were 62.5% ,61.4% , 72.9%, showing an upward trend. Cmpliance rates of admission of blood pressure were 27.0%, 26.6%, 27.9%, no significant difference, still at a low level. Compliance rates of discharge of blood pressure were 63.5%, 65.6%, 69.9%, showing an upward trend. In the choice of antihypertensive drugs, ACEI /ARB dominated, the application rates were 76.5%, 86.1%, 87.8%, showing an upward trend. The combined application of the rates of antihypertensive drugs in hypertension patients were 75.7%, 75.7%, 80.8%, showing an upward trend. Determination of the rates of admission blood lipids were 86.4%, 90.5%, 93.7%, showing an upward trend. Statins application rate were 74.3%, 79.7%, 83.3%, showing an upward trend ,there wase significant difference compared with each other. Blood lipids compliance rates were 39.2%, 42.6%, 47.8% in patients with stable angina. Compared with patients with stable angina, blood lipids compliance rates were 20.0%, 19.8%, 19.8% in patients with acute coronary syndrome, which was significantly lower than patients with SA in the same group. The proportion of diabetes mellitus in patients with CHD gradually increased, respectively, 28.4%, 26.6%, 40.0%.The fasting blood glucose monitoring rates were 73.8%, 79.9%, 90.7% and postprandial 2h plasma glucose monitoring rates were 22.6%, 21.7%, 59.9%, in 2008 blood glucose monitoring obviously improved. OGTT detection rates were 4.0%, 6.0%, 5.6%, no significant improvement and low. The application rate of individual anti-platelet drugs in patients with SA were 97.6%, 98.5%, 99.1%, no significant difference. In patients with acute coronary syndrome, the combination of aspirin and clopidogrel rates were 28.1%, 25.4%, 58.8%,the number of patients that receiving combined antiplatelet therapy was gradually increasing.Conclusion:Patients with CHD complicated with hypertension, diabetes are gradually increasing from year 2003 to 2008. The Admission blood pressure and lipid is not satisfactory, we should strengthen publicity and education, strengthen the management of risk factors for CHD outside the hospital, emphasizing the primary prevention of CHD. For the patient with CHD, we should pay more attention to blood glucose monitoring, espacially the postprandial 2h plasma glucose and OGTT, in order to early intervention for patient with abnormal blood glucose. The management of risk factors for coronary heart disease continue to improve from 2003 to 2008, but the gap between clinical and guidelines is still large. It is important to strengthen the secondary prevention of coronary heart disease.