180 Chapter 7 missing or incorrect values. In SURF CHD II, center coordinators took part in one-on-one meetings before and during data collection to ensure that the project implementation was adequate. These meetings proved helpful to clarify doubts about the protocol, especially the study objectives, patient inclusion criteria, and valid data sources such as pre-existing records and tests. Although the highest standards of quality assurance might not be feasible in all surveys, strategies to promote quality can be applied to pragmatic surveys that use existing data. IMPACT AND FUTURE DIRECTIONS IN SURVEYS ON SECONDARY PREVENTION OF CHD Capturing relevant information on secondary prevention, and the subsequent publication of results, has direct implications for daily practice and policy. Feedback to participating centers and periodicity are key elements that promote usefulness of surveys. Surveys can serve as clinical audits as they provide clinicians with a snapshot of the state of secondary prevention in their centers, and critical review of the results allows the implementation of changes in daily practice. National and center results of SURF CHD II were discussed during one-on-one meetings with the SURF CHD II coordination team and center coordinators. These meetings enriched the interpretation of results with the experiences of those working directly with patients to collect data, and supported center coordinators to critically review the results and identify pitfalls in risk factor management. For example, several center coordinators identified low levels of risk factor recording, and attributed them to recording not being a routine practice, lack of measurement tools, the need of patients to pay for additional tests, or doubts on the usefulness of measuring apparent risk factors such as high BMI or waist circumference. At national level, results of SURF CHD II in Morocco and Azerbaijan have identified challenges relevant in these countries, and highlighted the need for specific prevention strategies such as more widely available and affordable cardiac rehabilitation programs (67,68). Critical review of local results also helps considering and promoting improvements in secondary prevention. For example, SURF CHD II results of Azerbaijan (68) were presented in a national congress, where the value of complete recording of risk factor information was highlighted and discussed with an audience of health professionals in cardiology. Conducting surveys periodically allows to evaluate trends in secondary prevention over time. EUROASPIRE, for example, has conducted multiple waves that allow the study on trends on risk factors and medication use over decades (69). Periodical survey results can also help improve quality of care at participating centers, as comparison of risk factor and treatment levels can be used to evaluate the effectiveness of changes in care provision strategies. The simplified design of SURF CHD facilitates periodical data collection waves. To date SURF CHD has conducted two study rounds, and a re-audit is planned to allow centers and countries to compare the results to the previous phase and evaluate potential improvements and challenges in daily practice. Survey results are relevant to ultimately feedback to clinical guidelines (70), as they provide insights on risk factor levels, challenges in secondary prevention, and the extent to which
RkJQdWJsaXNoZXIy MTk4NDMw