European Heart Journal Advance Access originally published online on February 16, 2005
European Heart Journal 2005 26(10):1011-1022; doi:10.1093/eurheartj/ehi109
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The initial management of stable angina in Europe, from the Euro Heart Survey
A description of pharmacological management and revascularization strategies initiated within the first month of presentation to a cardiologist in the Euro Heart Survey of Stable Angina
1Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
2London School of Hygiene and Tropical Medicine, London, UK
3Hospital Universitario Gregorio Maranon, Madrid, Spain
4Policlinico S. Matteo, Pavia, Italy
5Clinical Epidemiology Unit, Erasmus MC, Rotterdam, The Netherlands
6Hopital Europeen Georges Pompidou, Paris, France
7Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyons, France
8Herzzentrum Luwigshafen, Ludwigshafen, Germany
9University of Newcastle upon Tyne, UK
10Adelaide and Meath incorporating National Children's Hospital, Dublin, Ireland
11Institute of Cardiology, Warsaw, Poland
12Aarhus University Hospital, Denmark
13University Medical Centre St Radboud, Nijmegen, The Netherlands
Received 9 June 2004; revised 29 November 2004; accepted 9 December 2004; online publish-ahead-of-print 16 February 2005.
* Corresponding author. Tel: +44 20 73518289; fax: +44 20 73518643. E-mail address: c.daly{at}rbh.nthames.nhs.uk
See page 949 for the editorial comment on this article (doi:10.1093/eurheartj/ehi294)
Aims In order to assess adherence to guidelines and international variability in management, the Euro Heart Survey of Newly Presenting Angina prospectively studied medical therapy, percutaneous coronary intervention (PCI), and surgery in patients with new-onset stable angina in Europe.
Methods and results Consecutive patients, 3779 in total, with a clinical diagnosis of stable angina by a cardiologist were enrolled. After initial assessment by a cardiologist, 78% were treated with aspirin, 48% with a statin, and 67% with a beta-blocker. ACE-inhibitors were prescribed by the cardiologist in 37% overall. Revascularization rates were low, with only 501 (13%) patients having PCI or coronary bypass surgery performed or planned. However, when restricted to patients with coronary disease documented within 4 weeks of assessment, over 50% had revascularization performed or planned. Among other factors, the national rate of angiography and availability of invasive facilities significantly predicted the likelihood of revascularization, OR 2.4 and 2.0, respectively.
Conclusion This survey shows a shortfall between guidelines and practice with regard to the use of evidence-based drug therapy and evidence that revascularization rates are strongly influenced by non-clinical, in addition to clinical, factors.
Key Words: Stable angina • Pharmacological therapy • Secondary prevention • Coronary revascularization
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