Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study

Arq Bras Cardiol. 2013 Mar;100(3):212-20. doi: 10.5935/abc.20130062.
[Article in English, Portuguese]

Abstract

Background: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient.

Objective: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies.

Methods: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed.

Results: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease.

Conclusion: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.

MeSH terms

  • Aged
  • Ambulatory Care / standards*
  • Brazil
  • Cardiovascular Agents / classification
  • Cardiovascular Agents / therapeutic use*
  • Cardiovascular Diseases / therapy*
  • Epidemiologic Methods
  • Evidence-Based Medicine / methods
  • Evidence-Based Medicine / standards*
  • Female
  • Humans
  • Life Style*
  • Male
  • Practice Guidelines as Topic / standards*
  • Risk Factors

Substances

  • Cardiovascular Agents