140 Chapter 6 The Survey in Risk Factors in Coronary Heart Disease II (SURF CHD II) Study is an easy-to perform clinical audit designed to evaluate compliance with clinical guidelines in secondary prevention in daily practice. In this article, SURF CHD II data are used to assess secondary prevention of CHD and to investigate potential inequalities in risk factor management. Specifically, we report the level of risk factor recording, guideline-defined target attainment and treatment in CHD outpatients and investigate differences by educational level. Our results can bring attention to potential health inequalities aimed at supporting the development of effective prevention strategies. METHODS Study design and data collection SURF CHD II consists of brief cross-sectional survey that collects data on demographics, risk factor history, risk factor measurements, medications, and participation in cardiac rehabilitation. The survey is performed as part of a clinical audit in consecutive patients with CHD attending routine outpatient visits. Centers that included ≥100 participants were included in the present analysis. The survey was completed from 2019 to 2022 in 105 centers located in 29 countries, including high-income countries (HICs) (Belgium, Chile, Croatia, Czech Republic, Denmark, Estonia, Greece, Hungary, Ireland, Italy, Latvia, Netherlands, Portugal, Romania, Saudi Arabia, Spain, and United States of America), upper middle-income countries (UMICs) (Argentina, Azerbaijan, Brazil, Kazakhstan, Libya, North Macedonia, Russia, Serbia, Turkey) and lower middle-income countries (LMICs) (India, Indonesia and Morocco) (10). Patient eligibility criteria are being 18 years or older and having a previous diagnosis of CHD, including stable angina pectoris (SAP), acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) (elective or acute) and/or coronary artery bypass graft (CABG) (elective or acute). SAP is defined as clinical angina with objective confirmation from ECG, ischemia on perfusion imaging, coronary angiogram showing a narrowing of 70% in at least one coronary artery. Data sources Data was obtained from medical records and patient interview by a physician or nurse. In Denmark, three centres Italy, the Netherlands, and the United States (11,12) participating centers extracted data from existing health registries of patients who were eligible for the study. Data was collected by use of the software RedCap (13). Ethical considerations Ethical approval for this study was waived by the Medical Ethics Committee of the University Medical Center Utrecht (protocol number 17/534). Ethical approval was obtained or waived in individual centers prior to participation. Data collection and variable definition
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