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European Heart Journal Advance Access originally published online on May 16, 2006
European Heart Journal 2006 27(11):1298-1304; doi:10.1093/eurheartj/ehl005
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina

Caroline Daly1,*, Felicity Clemens2, Jose L. Lopez-Sendon3, Luigi Tavazzi4, Eric Boersma5, Nicholas Danchin6, Francois Delahaye7, Anselm Gitt8, Desmond Julian9, David Mulcahy10, Witold Ruzyllo11, Kristian Thygesen12, Freek Verheugt13, Kim M. Fox1 on behalf of the Euro Heart Survey Investigators

1 Royal Brompton and Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
2 London School of Hygiene and Tropical Medicine, London, UK
3 Hospital Universitario Gregorio Maranon, Madrid, Spain
4 Policlinico S Matteo, Pavia, Italy
5 Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands
6 Hopital Europeen Georges Pompidou, Paris, France
7 Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyons, France
8 Herzzentrum Luwigshafen, Ludwigshafen, Germany
9 University of Newcastle upon Tyne UK
10 Adelaide and Meath Incorporating National Childrens' Hospital, Dublin, Ireland
11 Institute of Cardiology, Warsaw, Poland
12 Aarhus University Hospital Denmark
13 University Medical Centre St Radboud, Nijmegen, The Netherlands

Received 19 November 2005; revised 1 April 2006; accepted 6 April 2006; online publish-ahead-of-print 16 May 2006.

* Corresponding author. Tel: +44 207 3518626; fax: +44 207 3518643. E-mail address: caroline.daly{at}imperial.ac.uk

Aims The European Society of Cardiology published guidelines for the management of stable angina in 1997, with the objective of promoting an evidence-based approach to the condition. This study focuses on the impact of guideline compliant medical treatment on clinical outcome in patients with stable angina.

Methods and results The Euro Heart Survey of Stable Angina is a multicentre prospective observational study conducted between 2002 and 2003. Patients with a clinical diagnosis of stable angina by a cardiologist were enrolled and follow-up was conducted at 1 year. The primary outcome of interest was death or myocardial infarction (MI). The increasing intensity of guideline compliant medical therapy was quantified by means of a simple treatment score based on the use of guideline advocated therapies: antiplatelets, statins, and beta-blockers. A total of 3779 patients were included in the initial survey. Increasing intensity of guideline compliant therapy at initial assessment was associated with a reduction in death and MI during follow-up in patients with angina and confirmed coronary disease (HR 0.68; 95% CI 0.49–0.95 per unit increase in treatment score). All cardiovascular events were also significantly reduced in this subgroup (HR 0.82; 95% CI 0.69–0.97). The benefits of guideline compliant therapy were only observed in patients with objective evidence of coronary disease.

Conclusion Guideline compliant medical therapy improves clinical outcome in patients with stable angina and objective evidence of coronary disease.

Key Words: Guideline compliance • Prognosis • Evidence based therapy • Secondary prevention


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