Analysis Of The Control Of Risk Factors And Evidence-based Medicine After Coronary Revascularization In Patients With Coronary Artery Disease

Background and objectiveCardiovascular disease has become the major killer of human health. Globally,the number of death and cardiovascular disease increased by1/3from1990to2010,currently, the incidence of cardiovascular disease was "blowout" like bursting growth,the incidence has reached230million, plagued by physical and mental health andincreased health care burden. Coronary heart disease has become one of the higherrates of cardiovascular disease, with the development of medical technology, atpresent, the main treatment method for coronary heart disease include drug treatment,percutaneous coronary intervention (Percutaneous coronary intervention, PCI),coronary artery bypass grafting (Coronary artery bypass grafting, CABG), PCI andCABG referred to as revascularization。Revascularization can alleviate patient’ssymptoms and improve prognosis, but does not change the process of atherosclerosis,after revascularization there is also restenosis and adverse cardiovascular events。Research has shown that, the main effect of coronary atherosclerotic process is the control of risk factors and evidence-based medicine for coronary heart disease。Inclinical practice, some of the risk factors of coronary heart disease can be effectivelycontrolled through lifestyle changes or evidence-based medicine such as hypertension,diabetes, hyperlipidemia, smoking, obesity, lack of exercise, ect and so on. However,there are still the majority of people who with coronary heart disease afterrevascularization outside the hospital did not receive proper medical guidance, noawareness of disease prevention, recurrence rate and mortality of cardiovasculardisease on the rise, further aggravating the health care burden.Therefore, positive andeffective control outside the hospital coronary risk factors, delaying the process ofatherosclerosis, the merger taking secondary prevention medications that can reducethe recurrence rate of angina pectoris, myocardial infarction, heart failure, suddendeath and other cardiovascular events, in the long run, can improve the quality of lifein patients with long-term.This study show the situation of secondary prevention,through the investigation of risk factors and evidence-based medicine of coronaryheart disease patients with coronary artery disease underwent revascularization,provide the theory basis for the intervention of the future clinical work, minimize thegap between evidence-based medicine and clinical practice, enhance the effect ofsecondary prevention.Methods(1) collecting the data of patients with coronary heart revascularization inSecond Affiliated Hospital of Zhengzhou University Cardiovascular Surgery Clinicalfrom2010January to2013year in June;(2) Establish the follow-up questionnaire,survey patients with coronary artery disease after revascularization to understand thegeneral situation, the presence control of risk factors, evidence-based medicationoutside the hospital;(3)Summarize the relevant data collection, summary, usingSPSS17.0statistical software to analyze the control of risk factors and drug use, givehumans the guidance of life so that management measures can standardizedsecondary prevention of coronary heart disease。Results163cases were well followed up after revascularization in patients with anaverage age of52.59±10.62years, mean follow-up time of19.96±10.34months. Coronary revascularization in patients with postoperative follow-up smoking, weight,BMI, hypertension improved systolic and diastolic pressure compared with admission,the difference was statistically significant (P <0.05); fasting blood glucose,postprandial blood glucose, TG, LDL-C ratio was increased when compared tohospitalization, the difference was statistically significant (P <0.05). The number ofsmoker is declined， from63.80%down to15.34%at admission, no new staffsmoking; weight and BMI impromed at follow-up when compared with the case ofadmission, but there are still26.95%(38/141) of patients outside the hospitalweight control is not ideal;71.11%of the follow-up blood pressure in hypertensivepatients has improved over the admission, has13.64percent of the patients found noabnormalities in blood pressure hypertension follow-up time of admission; fastingplasma glucose and postprandial blood glucose on admission were compared withfollow-up of the increased25.71%fasting blood glucose control in diabetic patientsare not satisfied, the postprandial blood glucose monitoring rate is only28.22%,poor glycemic control in diabetic patients and40.00%of the25.00%of non-diabeticpatients with new-onset glucose abnormalities; triglycerides, low-density lipoproteincholesterol is not accounted for45.52percent compliance rate,40.62%,respectively, was increased when compared to the level and follow-up compared toadmission. Patients taking the drug situation outside the hospital: follow-up foundthat most patients can continue to follow postoperative hospital doctor to take drugs,but the rate of decline in overall medication. When the patient was discharged takingant platelet drugs, lipid-lowering statin drugs, β-blockers, angiotensin-convertingenzyme inhibitors (Angiotensin Converting Enzyme Inhibitor, ACEI)/angiotensin Ⅱreceptor blockers (Angiotensin Receptor Blocker, ARB) proportions were100%%,95.09%,88.96%,58.8%, while the follow-up of various types of drug use rateswere93.25%,77.30%,71.77%,41.72%. Among statin lipid-lowering drugs, B-blockers, ACEI/ARB taking rate has dropped significantly, and the difference wasstatistically significant (P <0.05). Cardiovascular events refer to low control of riskfactors and evidence-based medicine, the results showed: modifiable risk factors ofcoronary heart disease has not been effectively controlled in patients72.72%ofpatients with recurrent angina, hospitalization due to cardiovascular disease65.45%, 50.09%heart function≥NYHA III; patient drug treatment is not standardized, andoutside the hospital recurrent angina, rehospitalization, heart function≥NYHA IIIproportions were62.29%,49.18%,36.06%.Conclusion:1, The control of risk factors of the patients with coronary heart disease underrevascularization control is not ideal, modifiable risk factors smoking, blood pressure,blood sugar, cholesterol, body weight did not meet evidence-based medicineguidelines recommend targets.2, The secondary prevention of postoperative medication usage is not high forpatients. We should follow-up intervention and missionary, shorten the gap withevidence-based medicine guidelines, and improve the overall level of diseaseprevention.3, The risk factors of coronary heart disease needed to achieve effective controlof much effort, clinicians need to strengthen health intervention and follow-up, givingpatients the correct and effective prescription and lifestyle guidance; coronary heartdisease patients should actively follow the doctor’s orders, heart vascular disease havea new understanding; through joint efforts to improve the quality of life andlong-term prognosis of patients with coronary heart disease and improvecardiovascular disease prevention and control levels, and promote cardiacrehabilitation.