Persistence of uncontrolled cardiovascular risk factors in patients treated with percutaneous interventions for stable coronary artery disease not receiving cardiac rehabilitation

摘要

Background: Cardiac rehabilitation programmes are strongly recommended for all forms of coronary artery disease to reduce recurrent events and mortality. Few patients seem to participate in these programmes after elective percutaneous coronary intervention (PCI). The aim of this study was to assess changes in lifestyle and risk factors after PCI for patients with stable disease and not included in cardiac rehabilitation programmes. Methods: We prospectively enrolled 207 consecutive patients with stable disease who underwent a first elective PCI. Follow up was performed at 13.0±3.2 months for 94.7%; 28 patients were excluded due to participation in a cardiac rehabilitation programme. Baseline values from admission sheets were compared to follow up values collected from the treating physician. Results: At follow up, systolic and diastolic blood pressures dropped (p=0.001) as well as the prevalence of hypertension (p<0.001). Significant reductions in cholesterol (p<0.001) and blood glucose (p=0.004) were also noted. Low-density lipoprotein levels stayed outside target in 47.2% and high-density lipoprotein levels in 75.0% of patients initially presenting with lipid disorders. Obesity prevalence remained high at follow up. Only 45.6% were performing regular physical exercise and 8.3% of smokers quit smoking. Only 13.3% attended any form of dietary advice programme. HADS-A score was 5.1±3.9 and the HADS-D score was 3.8±3.6. SF 36 questionnaire revealed a good quality of life with a mean value of 45.6 for physical and 42.9 for mental wellbeing. Conclusion: A considerable percentage of patients receiving PCI for stable angina do not achieve lifestyle and risk factor goals and therefore remain at increased risk for recurrent events. Efforts should be initiated to better implement guidelines that strongly recommend secondary prevention through cardiac rehabilitation after elective PCI.