“Ischaemic heart disease (IHD) remains the major killer across the globe and particularly in Europe,” said principal investigator Professor Michel Komajda, professor of cardiology in the Department of Cardiology at University Pierre and Marie Curie and Pitié-Salpêtrière Hospital in Paris, France. “Although there have been substantial improvements in the management of these patients, IHD remains the most common condition in cardiology and is associated with very poor outcomes.”
European data on patients with CICD and their management is lacking. The Euro Heart Survey published in 2005 was limited to patients with stable angina.3 In addition, the diagnosis and treatment landscape has changed in the past ten years with new stress imaging modalities for diagnosis, more efficient revascularisation, and an ageing population.
The EORP4 CICD-Pilot was an international prospective observational longitudinal registry, conducted in 100 centres from ten countries across Europe with three year follow-up. From April 2013 to December 2014, the study enrolled 2 420 consecutive patients with a broad spectrum of IHD including non-ST-elevation myocardial infarction (NSTEMI), stable angina, peripheral artery disease (PAD) and patients undergoing elective percutaneous coronary intervention (PCI). Data was collected on clinical characteristics, investigations and medications.
The investigators found an increased rate of prescriptions of life-saving medications compared to the Euro Heart Survey. At discharge from hospital, 93% of patients received a statin (up from 48%), 65% received an angiotensin converting enzyme inhibitor (ACE I) (up from 40%), and 80% received a beta-blocker (up from 67%).
“The increase in medications is a good sign,” said Professor Komajda. “However, the proportion of patients who are taking all recommended medications at the same time remains suboptimal at 71% (ACE I/angiotensin receptor blocker (ARB), statin and aspirin) so there is room for improvement.”
The proportion of patients receiving diagnostic and prognostic procedures was well below that recommended by ESC guidelines.5 In particular the assessment of cardiac function, which is recommended for all patients with CICD, was performed in just 70% of cases. Only 21% of patients who should have had an ischaemic test in the year preceding inclusion in the registry actually had one.
The use of modern imaging modalities, including cardiac computed tomography, myocardial scintigraphy and cardiac magnetic resonance, for assessment of myocardial ischaemia was very low, at less than 5% overall, and most stress test procedures used the classical exercise test. Professor Komajda said: “We were surprised to find such a low use of the newer imaging techniques. This may be because more than 40% of patients were from Eastern Europe where these tests may not be affordable.”
Compared to the Euro Heart Survey, patients were older and more frequently had diabetes (29 vs 18%), dyslipidemia (74 vs 58%), hypertension (83 vs 62%), previous cerebrovascular disease (16 vs 5%) and malignancy (7% vs 2%). Within the CICD-Pilot Registry cohort, PAD patients were significantly older, had more comorbidities and were less treated with life-saving drugs.
“These results show that patients with CICD are more complex and have more comorbidities than ten years ago,” said Professor Komajda. “And in addition, patients affected by atherosclerosis have different clinical presentations. Our finding that patients with PAD receive fewer recommended medications could be because they are not referred to cardiac departments.”
He concluded: “We are launching the long-term phase of the CICD registry at ESC Congress in London. The target is to include 15 000 patients from as many European countries as possible. The survey will assess outcome measures and geographic variations. The data will ultimately be used to improve the diagnosis and treatment of patients with ischaemic heart disease.”
1Professor Komajda will give the lecture ‘Presentation of the main results of the pilot phase of the Chronic Ischemic Cardiovascular Disease’ registry at 14:45 during:
• The session ‘ESC registries’, an EORP Special Session on Tuesday 1 September at 14:00 in the St James Park (The Hub)
2Komajda M, Weidinger F, Kerneis M. EURObservational Research Programme: the Chronic Ischaemic Cardiovascular Disease Registry: Pilot phase (CICD – PILOT). European Heart Journal. 2015 [ehv437]
3Daly CA, Clemens F, Sendon JL, et al; Euro Heart Survey Investigators. The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable Angina. European Heart Journal. 2005;26:996-1010.
4About EORP: EURObservational Research Programme (EORP) is the large ESC registry programme. EORP aims at providing a better understanding of medical practice in Europe through the collection of observational data and at evaluating the implementation of ESC guidelines.
5Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal. 2013;34:2949-3003.
Notes to editor
SOURCES OF FUNDING: At the time of the registry, the following companies were supporting the EURObservational Research programme: Abbott Vascular Int., Amgen, Bayer Pharma AG, Boehringer Ingelheim, The Bristol Myers Squibb and Pfizer alliance, The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company, Merck & Co., Novartis Pharma AG, ResMed, SERVIER.
DISCLOSURES: SB – received Board membership fees from Pfizer Romania, AstraZeneca, Boehriger Ingelheim, Sanofi Aventis and SERVIER, lecture fees from Pfizer Romania, AstraZeneca, Boehrigner Ingelheim, Glenmark, Terapia SA, Sanofi Aventis and SERVIER, fees for development of educational presentations from Pfizer Romania, AstraZeneca and SERVIER, and travel/accomodation/meeting fees not related to the activities above from Pfizer Romania, AstraZeneca, SERVIER and Boehringer Ingelheim. FC – received consultancy fees from MSD and Roche, lecture fees from AstraZeneca, Roche, BMS, Abbot and Bayer. RF – reports grants and personal fees from Servier, Novartis, and Boehringer Ingelheim, personal fees from Merck Serono, Irbtech and Amgen. MK – reports Board membership fees from Novartis, BMS, AstraZeneca and Menarini, consultancy fees from SERVIER and Amgen, lecture fees from SERVIER, Sanofi, AstraZeneca, BMS, MSD, Menarini and Novartis, and some fees for some manuscript preparation from Menarini. MM – received lecture fees from SERVIER, Tecnimed and Bayer. GS – reports personal fees from Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Daiichi-Sankyo, GlaxoSmithKline, Lilly, MSD, Novartis, Otsuka, Pfizer, Roche, Medtronic, Vivus, Janssen, Orexigen and Regado, grants and personal fees from Sanofi and SERVIER, and personal fees and non-financial support from The Medicines Company. CT – reports grants from St Jude Medical, and travel/accomodation/meeting expenses not related to the activities above from St Jude Medical and Medtronic. LT – reports Board membership fees from SERVIER, Boston Scientific, Cardiorentis, Medtronic, CVIE Therapeutics and St Jude Medical, and lecture fees from SERVIER. AC – reports consultancy fees from Medtronic and Boston Scientific, and reports grants paid to his institution from Abbot Vascular and Terumo. IM – reports lecture fees from Servier, Berlin chemie, Bayer, Boeringer Ingelheim and Takeda, and reports employment fees paid to her institution from P.Stradins Clinical University hospital. APM – reports Board membership fees as Steering Committee member from Novartis, Bayer and Cardiorentis. MK – reports personal fees as Research Fellow for the CICD Pilot registry. Other authors: none to declare.
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