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Aspects on implementation of coronary heart disease prevention in clinical practice

Stagmo, Martin LU (2005)
Abstract
Prevention of first time disease or recurrence of coronary heart disease (CHD) is a major task for the health service. Guidelines regarding CHD prevention have been issued but studies have shown that treatment goals are inadequately met in clinical practice and there is urgent need for improved methods of implementation of guidelines. There is also a need for better risk stratification tools in order to identify asymptomatic subjects with a high risk for future CHD.



This thesis has shown that:



A structured, one-year, hospital-based secondary prevention programme after CHD, mainly led by specialist nurses with physician backup, could positively influence the use of lipid-lowering drugs and serum... (More)
Prevention of first time disease or recurrence of coronary heart disease (CHD) is a major task for the health service. Guidelines regarding CHD prevention have been issued but studies have shown that treatment goals are inadequately met in clinical practice and there is urgent need for improved methods of implementation of guidelines. There is also a need for better risk stratification tools in order to identify asymptomatic subjects with a high risk for future CHD.



This thesis has shown that:



A structured, one-year, hospital-based secondary prevention programme after CHD, mainly led by specialist nurses with physician backup, could positively influence the use of lipid-lowering drugs and serum cholesterol levels several years after the end of the programme.



A quality control system based on patient empowerment and education with continuous feedback to patients, nurses and physicians seemed to be welcomed by both patients and participating health care professionals. However, our system based on voluntary participation and report cards did not seem to be feasible at this time due to a high dropout rate.



Reasons why targets for serum lipids were not met in the EUROASPIRE II study were that too few patients received lipid-lowering drugs, and that of those who did receive such treatment many were treated with sub-optimal doses.



Ambulatory ECG with ST-analysis could add significant information on which healthy subjects with a certain accumulation of risk factors who would suffer from a major coronary event (death, AMI or revascularisation) over a 15-year time period. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Rydén, Lars, Karolinska Universitetssjukhuset, Solna
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Medicin (människa och djur), Kardiovaskulära systemet, Cardiovascular system, Medicine (human and vertebrates), nurse-led clinics, risk stratification, Implementation, Coronary hert disease, prevention
pages
116 pages
publisher
Medicinsk Informationsteknik, Malmö
defense location
Aulan Ing 35 Universitetssjukhuset MAS 20502 Malmö Sweden
defense date
2005-10-14 13:00:00
ISBN
91-85439-72-X
language
English
LU publication?
yes
additional info
M Stagmo, L Westin, R Carlsson and B Israelsson. 2001. Long-term effects on cholesterol levels and the utilisation of lipid-lowering drugs of a hospitalbased programme for secondary prevention of coronary heart disease. J Cardiovasc Risk, vol 8 pp 243-8.
M Stagmo, B Israelsson, H Brandström and H Lingfors. 2004. The Swedish National Programme for Quality Control of Secondary Prevention of Coronary Artery Disease - results after one year. Eur J Cardiovasc Prev Rehabil, vol 11 pp 18-24.
K Kotseva, M Stagmo and D Wood. . Treatment potential for cholesterol management in patients with coronary heart disease in fifteen European countries: findings from the EUROASPIRE II study. (manuscript)
M Stagmo, S Juul-Möller and B Israelsson. . Fifteen-year risk of major coronary events predicted by Holter ST-monitoring in healthy middle-aged men. Eur J Cardiovasc Prev Rehabil. (inpress)
id
e548b098-1abb-4563-849c-5b6c756ff972 (old id 545430)
date added to LUP
2016-04-01 17:09:22
date last changed
2018-11-21 20:47:05
@phdthesis{e548b098-1abb-4563-849c-5b6c756ff972,
  abstract     = {{Prevention of first time disease or recurrence of coronary heart disease (CHD) is a major task for the health service. Guidelines regarding CHD prevention have been issued but studies have shown that treatment goals are inadequately met in clinical practice and there is urgent need for improved methods of implementation of guidelines. There is also a need for better risk stratification tools in order to identify asymptomatic subjects with a high risk for future CHD.<br/><br>
<br/><br>
This thesis has shown that:<br/><br>
<br/><br>
A structured, one-year, hospital-based secondary prevention programme after CHD, mainly led by specialist nurses with physician backup, could positively influence the use of lipid-lowering drugs and serum cholesterol levels several years after the end of the programme.<br/><br>
<br/><br>
A quality control system based on patient empowerment and education with continuous feedback to patients, nurses and physicians seemed to be welcomed by both patients and participating health care professionals. However, our system based on voluntary participation and report cards did not seem to be feasible at this time due to a high dropout rate.<br/><br>
<br/><br>
Reasons why targets for serum lipids were not met in the EUROASPIRE II study were that too few patients received lipid-lowering drugs, and that of those who did receive such treatment many were treated with sub-optimal doses.<br/><br>
<br/><br>
Ambulatory ECG with ST-analysis could add significant information on which healthy subjects with a certain accumulation of risk factors who would suffer from a major coronary event (death, AMI or revascularisation) over a 15-year time period.}},
  author       = {{Stagmo, Martin}},
  isbn         = {{91-85439-72-X}},
  keywords     = {{Medicin (människa och djur); Kardiovaskulära systemet; Cardiovascular system; Medicine (human and vertebrates); nurse-led clinics; risk stratification; Implementation; Coronary hert disease; prevention}},
  language     = {{eng}},
  publisher    = {{Medicinsk Informationsteknik, Malmö}},
  school       = {{Lund University}},
  title        = {{Aspects on implementation of coronary heart disease prevention in clinical practice}},
  url          = {{https://lup.lub.lu.se/search/files/4891967/545432.pdf}},
  year         = {{2005}},
}