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Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland

Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has...

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Autores principales: Repo, Teppo, Tykkyläinen, Markku, Mustonen, Juha, Rissanen, Tuomas T., Ketonen, Matti, Toivakka, Maija, Laatikainen, Tiina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923766/
https://www.ncbi.nlm.nih.gov/pubmed/29641497
http://dx.doi.org/10.3390/ijerph15040724
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author Repo, Teppo
Tykkyläinen, Markku
Mustonen, Juha
Rissanen, Tuomas T.
Ketonen, Matti
Toivakka, Maija
Laatikainen, Tiina
author_facet Repo, Teppo
Tykkyläinen, Markku
Mustonen, Juha
Rissanen, Tuomas T.
Ketonen, Matti
Toivakka, Maija
Laatikainen, Tiina
author_sort Repo, Teppo
collection PubMed
description Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients (n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.
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spelling pubmed-59237662018-05-03 Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland Repo, Teppo Tykkyläinen, Markku Mustonen, Juha Rissanen, Tuomas T. Ketonen, Matti Toivakka, Maija Laatikainen, Tiina Int J Environ Res Public Health Article Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients (n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right. MDPI 2018-04-11 2018-04 /pmc/articles/PMC5923766/ /pubmed/29641497 http://dx.doi.org/10.3390/ijerph15040724 Text en © 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Repo, Teppo
Tykkyläinen, Markku
Mustonen, Juha
Rissanen, Tuomas T.
Ketonen, Matti
Toivakka, Maija
Laatikainen, Tiina
Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title_full Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title_fullStr Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title_full_unstemmed Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title_short Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland
title_sort outcomes of secondary prevention among coronary heart disease patients in a high-risk region in finland
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923766/
https://www.ncbi.nlm.nih.gov/pubmed/29641497
http://dx.doi.org/10.3390/ijerph15040724
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