Variation in Secondary Prevention of Coronary Heart Disease: The INTERASPIRE Study

McEvoy JW 1 , Jennings C 1 , Kotseva K 1 , De Bacquer D 2 , De Backer G 2 , Erlund I 3 Show all authors , Vihervaara T 3 , Lip GYH 4 , Ray K 5 , Rydén L 6 , Abreu A 7 , Almahmeed W 8 , Meidian Ambari A 9 , Ge J 10 , Hasan-Ali H 11 , Huo Y 12 , Jankowski P 13 , Jimenez RM 14 , Li Y 15 , Zuhdi ASM 16 , Makubi A 17 , Mbakwem AC 18 , Mbau L 19 , Navarro Estrada JL 20 , Ogah OS 21 , Ogola EN 22 , Quintero-Baiz A 23 , Sani MU 24 , Sosa Liprandi MI 25 , Tan JWC 26 , Urina Triana MA 27 , Yeo TJ 28 , Ganly S 1 , Adamska A 1 , Wood D 1

Affiliations 

  • 1 University of Galway School of Medicine and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway H91 FF68, Ireland
  • 2 Department of Public Health and Primary Care, Ghent University, Gent, Belgium
  • 3 Biomarkers, Department of Government Services, Finnish Institute for Health and Welfare, Finland
  • 4 Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
  • 5 Department of Public Health and Primary Care, Imperial College London, UK
  • 6 Department of Medicine Solna, Karolinska Institutet, 171 76 Stockholm, Sweden
  • 7 Faculty of Medicine, University of Lisbon (FMUL), University Hospital of Santa Maria, CHULN, Av. Egas Moniz, 1649-082, Lisbon, Portugal
  • 8 Cleveland Clinic Abu Dhabi, Al Mariah Island, Abu Dhabi, United Arab Emirates
  • 9 National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West Jakarta, Jakarta, Indonesia
  • 10 Fudan University Zhongshan Hospital, Floor 15, Building 16, No. 1609 Xietu Road, Xuhui District, Shanghai 200000, China
  • 11 Cardiovascular Medicine Department, Assiut University Heart Hospital, 71111, Assiut, Egypt
  • 12 Peking University First Hospital, Department of Cardiology, Institute of Cardiovascular Disease, No. 8 XiShiku Street, Xicheng District, Beijing 100034, China
  • 13 Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 231 Czerniakowska St, 00-416 Warsaw, Poland
  • 14 Philippine Heart Association & St. Luke's Medical Center, Global City, Rizal Avenue Corner 32nd Street, Taguig City, Metro Manila, Philippines
  • 15 Department of Internal Medicine (Cardiology), Fudan University Huashan Hospital, 12 Wulumuqi Zhong Rd, Shanghai 200040, China
  • 16 University Malaya Medical Centre, Cardiology Unit, Department of Medicine, 59100 Kuala Lumpur, Malaysia
  • 17 Muhimbili Orthopedic Institute (MOI), P.O BOX 65474, Dar es salaam, Tanzania
  • 18 Department of Medicine, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
  • 19 Kenya Cardiac Society, P.O Box, 8038-00100, Nairobi, Kenya
  • 20 Italian Hospital of Buenos Aires, Gascon 450 (1181) Buenos Aires, Argentina
  • 21 Cardiology Unit, Department of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
  • 22 Department of clinical medicine and therapeutics, University of Nairobi, P. O. Box 19676, Nairobi, Kenya
  • 23 Faculty of Health Sciences, University Simon Bolivar, Cra 50 # 80 - 216 office 109 Barranquilla, Colombia
  • 24 Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, PMB 3452, Kano 700223, Kano State, Nigeria
  • 25 Cardiology Service, University Hospital Sanatorio Güemes, Francisco Acuna de Figueroa 1240, (Zip code 1180), Buenos Aires, Argentina
  • 26 National Heart Centre Singapore, Singapore; (2) Duke-NUS Medical School, Singapore; (3) Department of Cardiology, Sengkang General Hospital, Singapore, Singapore, National Heart Centre, Singapore, 5 Hospital Dr, Singapore 169609, Singapore
  • 27 Faculty of Health Sciences, Universidad Simon Bolivar, Carrera 59 # 59-65, Barranquilla, Colombia
  • 28 National University Heart Centre Singapore and National University Hospital, National University Health System (NUHS) Tower Block, 1E Lower Kent Ridge Road, Level 9, Cardiac Department, Singapore 119228, Singapore
Eur Heart J, 2024 Aug 30.
PMID: 39212219 DOI: 10.1093/eurheartj/ehae558

Abstract

BACKGROUND AND AIMS: INTERASPIRE is an international study of coronary heart disease (CHD) patients, designed to measure if guideline standards for secondary prevention and cardiac rehabilitation are being achieved in a timely manner.

METHODS: Between 2020-2023, adults hospitalized in the preceding 6-24 months with incident or recurrent CHD were sampled in 14 countries from all 6 World Health Organization regions and invited for a standardized interview and examination. Direct age and sex standardization was used for country-level prevalence estimation.

RESULTS: Overall, 4548 (21.1% female) CHD patients were interviewed a median of 1.05 (interquartile range 0.76-1.45) years after index hospitalization. Among all participants, 24% were obese (40% centrally). Only 38.5% achieved a blood pressure (BP) <130/80 mmHg and 19.2% a low-density lipoprotein cholesterol (LDL-C) of <1.4 mmol/l. Of those smoking at hospitalization, 48% persisted at interview. Of those with known diabetes, 56% achieved glycated hemoglobin (HbA1c) of <7.0%. A further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. Females were less likely to achieve targets: BP (females 37.4% males 38.6%), LDL-C (females 13.7% males 18.6%) and HbA1c in diabetes (females 47.7% males 57.5%). Overall, just 9.0% (inter-country range 3.8%-20.0%) reported attending cardiac rehabilitation and 1.0% (inter-country range 0.0%-2.4%) achieved the study definition of optimal guideline adherence.

CONCLUSIONS: INTERASPIRE demonstrates inadequate and heterogeneous international implementation of guideline standards for secondary prevention in the first year after CHD hospitalization, with geographic and sex disparity. Investment aimed at reducing between-country and between-individual variability in secondary prevention will promote equity in global efforts to reduce the burden of CHD.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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