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6-month rehospitalization, mortality rates high in patients with CAD, PAD
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Nearly one-quarter of patients with stable CAD or peripheral artery disease died or were rehospitalized at 6 months, according to a study published in the European Journal of Preventive Cardiology.
“Coronary artery disease is the leading cause of death worldwide, yet some patients appear to get lost in the system after their initial visit to a hospital or outpatient clinic,” Michel Komajda, MD, professor of cardiology at the University Pierre and Marie Curie and Pitié-Salpêtrière Hospital in Paris, said in a press release.
Researchers analyzed data from 2,200 patients (mean age, 67 years; 31% women) from 100 centers in 10 European countries. Patients were categorized into four cohorts:
- cohort 1: patients with chronic CAD and non-ST-elevation ACS who underwent PCI;
- cohort 2: those with chronic stable CAD who underwent elective coronary intervention;
- cohort 3: patients with stable CAD who were enrolled in general hospitals or clinics without CV or interventional surgery facilities; and
- cohort 4: those who underwent PAD interventions.
At 6 months, patients were assessed for CV and non-CV death, all-cause death, all-cause rehospitalization and CAD-related, CV and non-CV rehospitalization. The primary outcome of interest was a composite endpoint of all-cause rehospitalization or all-cause death. Patients were followed up for a mean of 7.2 months.
During follow-up, 2.6% of patients died. All-cause rehospitalization or all-cause death occurred in 23.7% of patients. These patients were more likely to be older and had peripheral revascularization, a history of previous non-STEMI, chronic obstructive pulmonary disease or chronic kidney disease.
The prescription of ACE inhibitors, beta-blockers, angiotensin receptor blockers, antiplatelet agents and mineralocorticoid receptor antagonists mildly decreased during follow-up (P for all < .02).
Independent predictors of all-cause hospitalization and all-cause death included a history of previous peripheral revascularization (HR = 1.45; 95% CI, 1.03-2.03), age per 10 years (HR = 1.17; 95% CI, 1.07-1.27), history of chronic obstructive pulmonary disease (HR = 1.42; 95% CI, 1.06-1.91) and a history of chronic kidney disease (HR = 1.31; 95% CI, 1.03-1.68).
Northern, Eastern and Western countries had higher event rates compared with Southern countries. Patients in cohort 1 had higher event rates than those in other cohorts.
“The medical management of this condition remains suboptimal and emphasizes the need to conduct a larger registry with long-term follow-up to evaluate clinical practice in Europe and improve the management of [chronic ischemic CVD] patients,” Komajda and colleagues wrote. “Specific programs to improve adherence to guidelines and follow-up procedures should be promoted by scientific societies and/or health care systems.” – by Darlene Dobkowski
Disclosures: Komajda reports he receives personal fees from Amgen, Bristol-Myers Squibb, Menarini, Novartis, Novo Nordisk, Sanofi, Servier and Torrent. Please see the study for all other authors’ relevant financial disclosures.
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