Secondary prevention in patients with coronary heart disease after in-hospital rehabilitation

Backround and objective: Data on impressive improvements in the prognosis and clinical progress of patients with coronary heart disease (CHD) through consistent reduction of risk factors and administration of cardioprotective drugs have led to the formulation of guidelines by professional associations. The aim of this prospective, multicenter cohort study (PIN: Post-Infarkt-Nachsorge=Postinfarction Aftercare) was to determine the extent to which these recommendations are implemented in the long term in patients who have had an acute coronary event and are undergoing rehabilitation therapy. Patients and methods: From January to May 1997, 2441 patients at 18 rehabilitation centers (22% women, 65 +/- 10 years: 78% men, 60 +/- 10 years) with diagnosed CHD following an acute cardiac event were enrolled in the study. Risk factors and pharmacologic therapy were recorded by the patients' GPs on a standardized questionnaire on admission to and discharge from rehabilitation therapy (RT) as well as after 3, 6, and 12 months. New clinical events were documented by questioning the patients and their attending physicians. Results: After an impressive reduction of cardiovascular risk factors during RT, the percentage of patients with blood pressure values >140/90 mmHg rose from 8% to 25% after 12 months (p<0.001). 11% vs 17% of the patients had glucose levels >140 mg/dl and 29% vs 51% had total cholesterol levels >200 mg/dl (p<0.001). 5% of the patients smelted at the time of discharge, 10% after one year. Compared to the time of discharge, significantly fewer <beta>-receptorblockers, lipid-lowering drugs, angiotensin converting-enzyme (ACE) inhibitors, and acetylsalicylic acid were prescribed. During follow-up observation, 886 patients suffered one or more clinical events, of which 69% occurred in the first six months. Conclusion: The interventional success of in-patient rehabilitation therapy is not sustained in the long term. This could be due to deficient implementation of guidelines for the secondary prevention of CHD, as the cardiovascular risk factors exceed pathological limits in a large proportion of patients and the prescription of cardioprotective medications is less than optimal.