European Heart Journal Advance Access published online on May 16, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl005
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1 Royal Brompton and Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
* To whom correspondence should be addressed. 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.
Received November 19, 2005
Revised April 1, 2006
Accepted April 6, 2006
Clinical research
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 Daly 1 *,
Felicity Clemens 2,
Jose L. Lopez Sendon 3,
Luigi Tavazzi 4,
Eric Boersma 5,
Nicholas Danchin 6,
Francois Delahaye 7,
Anselm Gitt 8,
Desmond Julian 9,
David Mulcahy 10,
Witold Ruzyllo 11,
Kristian Thygesen 12,
Freek Verheugt 13,
Kim M. Fox 1,
and
on behalf of the Euro Heart Survey Investigators
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
Caroline Daly, E-mail: caroline.daly{at}imperial.ac.uk
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