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Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

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Abstract
Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.
Keywords
Glycaemic control, Coronary artery disease, CARDIOVASCULAR-DISEASES, Management, Guideline adherence, Blood lipids, Blood pressure, Type 2 diabetes, Secondary prevention, MYOCARDIAL-INFARCTION, GLUCOSE CONTROL, BLOOD-GLUCOSE, RISK-FACTORS, FOLLOW-UP, MELLITUS, MORTALITY, HEART, GUIDELINES

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Chicago
Gyberg, Viveca, Dirk De Bacquer, Gui De Backer, Catriona Jennings, Kornelia Kotseva, Linda Mellbin, Oliver Schnell, et al. 2015. “Patients with Coronary Artery Disease and Diabetes Need Improved Management: a Report from the EUROASPIRE IV Survey: a Registry from the EuroObservational Research Programme of the European Society of Cardiology.” Cardiovascular Diabetology 14.
APA
Gyberg, V., De Bacquer, D., De Backer, G., Jennings, C., Kotseva, K., Mellbin, L., Schnell, O., et al. (2015). Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. CARDIOVASCULAR DIABETOLOGY, 14.
Vancouver
1.
Gyberg V, De Bacquer D, De Backer G, Jennings C, Kotseva K, Mellbin L, et al. Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. CARDIOVASCULAR DIABETOLOGY. 2015;14.
MLA
Gyberg, Viveca, Dirk De Bacquer, Gui De Backer, et al. “Patients with Coronary Artery Disease and Diabetes Need Improved Management: a Report from the EUROASPIRE IV Survey: a Registry from the EuroObservational Research Programme of the European Society of Cardiology.” CARDIOVASCULAR DIABETOLOGY 14 (2015): n. pag. Print.
@article{6992854,
  abstract     = {Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. 
Methods: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. 
Results: A total of 2846 (46 \%) patients had no diabetes, 1158 (19 \%) newly diagnosed diabetes and 2183 (35 \%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 \%, respectively. A blood pressure target of {\textlangle}140/90 mmHg was achieved in 68, 61, 54 \% and a LDL-cholesterol target of {\textlangle}1.8 mmol/L in 16, 18 and 28 \%. Patients with newly diagnosed and previously known diabetes reached an HbA1c {\textlangle}7.0 \% (53 mmol/mol) in 95 and 53 \% and 11 \% of those with previously known diabetes had an HbA1c {\textrangle}9.0 \% ({\textrangle}75 mmol/mol). Of the patients with diabetes 69 \% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (approximate to 40 \%) and only 27 \% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. 
Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.},
  articleno    = {133},
  author       = {Gyberg, Viveca and De Bacquer, Dirk and De Backer, Gui and Jennings, Catriona and Kotseva, Kornelia and Mellbin, Linda and Schnell, Oliver and Tuomilehto, Jaakko and Wood, David and Ryd{\'e}n, Lars and Amouyel, Philippe and Bruthans, Jan and Conde, Almundena Castro and Cifkova, Renata and Deckers, Jaap W and De Sutter, Johan and Dilic, Mirza and Dolzhenko, Maryna and Erglis, Andrejs and Fras, Zlatko and Gaita, Dan and Gotcheva, Nina and Goudevenos, John and Heuschmann, Peter and Laucevicius, Aleksandras and Lehto, Seppo and Lovic, Dragan and Mili\v{c}i\'{c}, Davor and Moore, David and Nicolaides, Evagoras and Oganov, Raphael and Paj\k{a}k, Andrzej and Pogosova, Nana and Reiner, Zeljko and Stagmo, Martin and St{\"o}rk, Stefan and Tokg{\"o}zo\u{g}lu, Lale and Vulic, Dusko},
  issn         = {1475-2840},
  journal      = {CARDIOVASCULAR DIABETOLOGY},
  keyword      = {Glycaemic control,Coronary artery disease,CARDIOVASCULAR-DISEASES,Management,Guideline adherence,Blood lipids,Blood pressure,Type 2 diabetes,Secondary prevention,MYOCARDIAL-INFARCTION,GLUCOSE CONTROL,BLOOD-GLUCOSE,RISK-FACTORS,FOLLOW-UP,MELLITUS,MORTALITY,HEART,GUIDELINES},
  language     = {eng},
  pages        = {11},
  title        = {Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology},
  url          = {http://dx.doi.org/10.1186/s12933-015-0296-y},
  volume       = {14},
  year         = {2015},
}

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