176 Chapter 7 Surveys can assess whether health professionals comply with guideline recommendations by capturing data on patient’s prescriptions, referral to cardiac rehabilitation programs, and advice and support received to change health behaviors. Clinical guidelines also recommend the recording of risk factor information (5). Analyzing missing information on risk factor recording provides important insights. In the SURF CHD survey, where blood pressure and smoking data were observed to be recorded regularly, while information was often unavailable for other risk factors such as BMI, lipids and waist circumference (24) (Chapter 6). From the patients’ perspective, most surveys ask patients whether they are using the prescribed medications and have participated in cardiac rehabilitation (24,45,48,49), and comprehensive surveys in clinical settings dive deeper and include questions on medication adherence, and actual changes on health behaviors (11). Although surveys report high prescription and medication use rates, patients seem to find it challenging to adhere to medications and change health behaviors (50) and to access cardiac rehabilitation programs that are not widely available in many countries (51). Patient outcomes Comprehensive surveys capture information on quality of life related measures, including physical and emotional well-being, and follow-up patients to for recurrent events. With this information, factors associated with morbidity and mortality risks can be identified. The EUROASPIRE survey reported higher health related quality of life among patients who changed health behaviors (52), and lower relative risks of cardiovascular mortality among patients with controlled risk factors (53), emphasizing the importance of secondary prevention for clinically relevant patient outcomes. Patient characteristics and health inequities Capturing information on patient’s characteristics allows the identification of patient groups with specific risk factor and care patterns, allowing research on optimal risk factor management and treatment strategies in diverse population groups. Data on patient characteristics can also provide insights on potential health inequities. Multiple surveys have reported sex, ethnicity, and socioeconomic disparities in secondary prevention outcomes including risk factor target attainment, presence of multiple risk factors, participation in cardiac rehabilitation, and barriers to access and afford health care (14,18,33,54) (Chapters 2 and 6). The findings of this thesis highlight health inequities in secondary prevention of CHD. In Argentina, Chile, and Uruguay, women with CHD presented a significantly higher burden of multiple risk factors (rate ratio 1.05, 95% confidence interval 1.02-1.08) (33). More than one fifth of the subjects with CHD in the CESCAS Study reported that they could not receive necessary medical care, and this was reported more often by patients covered only by the public healthcare system than by those with additional coverage (26.1% vs 13.2%, p=0.001) (Chapter 2). In the SURF CHD II study, those with secondary or tertiary educational level were
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