Adherence to European Clinical Practice Guidelines for Secondary Prevention of Cardiovascular Disease: A Cohort Study

To provide a better understanding of the actions taken within health systems and their results, this study aims to assess clinicians' adherence to clinical practice guidelines (CPGs) regarding recommended treatments in patients with cardiovascular disease in primary care settings, and to determine the associated factors. We conducted an ambispective cohort study in 21 primary care centres in 8 Spanish regions. Patients diagnosed with coronary heart disease, stroke and/or peripheral arterial disease were included. Patients who received the treatment recommended in the European guidelines on cardiovascular disease prevention (CPG's adherent group) were compared with patients who did not (CPG's non-adherent group). The outcome variables were cardiovascular hospital admissions, all-cause and cardiovascular mortality during follow-up. Of the 438 participants, 38.6% (n = 169) received the drug therapies recommended in the guidelines. The factors that increased the likelihood of good adherence to CPG's were being diagnosed with hypertension (p = 0.001), dyslipidaemia (p < 0.001) or diabetes (p = 0.001), and not having a psychiatric disorder (p = 0.005). We found no statistically significant association between good adherence to CPG's and lower incidence of events (p = 0.853). Clinician adherence to guidelines for secondary prevention of cardiovascular disease was low in the primary care setting.