Auditing secondary prevention of ischaemic heart disease in rural areas of Spain: An opportunity for improvement

Figures & data

Table I.  Sample characteristics.

Age, >65 years	779 (75.6%)
Inhabitants^a	792 (4–15 000)
Time to HC, min^b	5 (0–45)
Time to SS, min^b	30 (0–180)
Gender, male	716 (69.6%)
Diabetes	282 (27.4%)
AMI	571 (55.6%)
Angina	642 (62.0%)
No specialist visit^c	297 (28.9%)

Values are median (range) or n (%).

^a Number of inhabitants of town/village of residence.

^b Usual travelling time, in minutes, from town/village of residence to the town/village of the health centre (HC) or the specialist's surgery (SS), by car.

^c Patients who did not visit their specialist in the previous 12 months.

AMI: acute myocardial infarction.

Table II.  Results.

Fulfilment of criteria	%
BP < 140/90 mmHg	68.1
LDL < 100 mg/dl (2.6 mmol/l)	30.9
LDL < 130 mg/dl (3.4 mmol/l)	72
BMI < 30 kg/m^2	62.5
BMI < 25 kg/m^2	19.6
Non-sedentary	69.7
Non-smoking	92.2
Two BP previous 6 months	69.7
One LDL check previous 6 months	59.5
Two weight checks previous 6 months	43.6
Prophylactic drug consumption
Antiaggregant/anticoagulants	85
Hypolipidaemic agents	65.3
Beta-blockers	48.5
ACE inhibitors	37.7
Angiotensin II antagonist	8.1

BP: blood pressure; LDL: low-density lipoprotein; BMI: body-mass index; ACE: angiotensin-converting enzyme.

Table III.  Factors associated with fulfilment of quality criteria (multivariate analysis).

	aOR (95% CI)
BP in range
Gender: male	1.62 (1.15–2.28)†
Visits to specialist	1.47 (1.02–2.13)*
LDL < 100 mg/dl
Age over 65	1.76 (1.17–2.65)†
Visits to specialist	1.57 (1.03–2.38)†
LDL < 130 mg/dl
Visits to specialist	1.58 (1.08–2.31)*
BMI > 25 kg/m^2
Diabetes	1.73 (1.07–2.78)†
Age over 65	0.57 (0.34–0.94)*
BMI > 30 kg/m^2
Diabetes	1.68 (1.19–2.38)†
Gender: male	0.67 (0.47–0.95)*
Sedentarism
Gender: male	0.36 (0.25–0.50)‡
Smoking
Gender: male	3.50 (1.61–7.62)†
Age over 65	0.30 (0.18–0.50)‡
Visits to specialist	0.47 (0.28–0.79)†
BP 6 months
Diabetes	2.08 (1.40–3.09)‡
Age over 65	2.22 (1.51–3.26)‡
Gender: Male	0.58 (0.39–0.84)†
Visits to specialist	2.38 (1.66–3.43)‡
LDL previous 6 months
Diabetes	1.95 (1.38–2.76)‡
Age over 65	0.63 (0.45–0.90)*
Inhabitant's nucleus population
Town/village > 3400 inhabitants (basal: village < 294)	2.02 (1.13–3.61)*
Town/village 294–3400 (basal: village < 294)	1.80 (1.18–2.76)†
Visits to specialist	1.57 (1.13–2.20)†
Two weight checks 6 months
Diabetes	2.91 (1.97–4.30)‡
Age over 65	1.57 (1.05–2.33)*
Visits to specialist	1.57 (1.05–2.33)*

* p < 0.05, † p<0.01, ‡ p < 0.001.

Factors analysed: gender, age group, population of place of residence (fewer than 294, 295–3400, 3401 and over), distance from patient's town/village of residence to locality of health centre and specialist's surgery, diabetes, visits to specialist, history of AMI, and history of angina.

aOR (95% CI): adjusted odds ratio (95% confidence interval); BP: blood pressure; LDL: low-density lipoprotein; inhabitant's nucleus population: no. of inhabitants of patient's town/village of residence; BMI: body-mass index.

Table IV.  Factors associated with prescription of recommended drugs (multivariate analysis).

	aOR (95% CI)
Hypolipidaemic agent
Diabetes	1.44 (1.03–2.01) †
AMI	1.80 (1.20–2.69) †
Age over 65	0.47 (0.33–0.69) ‡
Inhabitant's nucleus population
Town/village > 3400 inhabitants (basal: village < 294)	1.60 (1.11–2.32) †
Visits to specialist	2.41 (1.76–3.31) ‡
Antiaggregant/anticoagulant
Diabetes	1.88 (1.14–3.10) *
AMI	2.41 (1.30–4.48) †
Visits to specialist	3.63 (2.38–5.53) ‡
Beta-blocker
Age over 65	0.52 (0.38–0.73) ‡
Visits to specialist	1.86 (1.36–2.56) ‡
AMI angina	1.71 (1.14–2.57) †
ACE inhibitors
Diabetes	1.90 (1.39–2.61) ‡
AMI	1.70 (1.16–2.50) †
Visits to specialist	1.70 (1.23–2.37) †

* p<0.05, † p<0.01, ‡ p<0.001.

Factors analysed: gender, age group, population of place of residence (fewer than 294, 295–3400, 3401 and over), distance from patient's town/village of residence to locality of health centre and specialist's surgery, diabetes, visits to specialist, history of AMI, and history of angina.

aOR (95% CI): adjusted odds ratio (95% confidence interval); inhabitant's nucleus population: no. of inhabitants of patient's town/village of residence; ACE: angiotensin-converting enzyme.

Table V.  Comparison of certain variables with studies published in Spain between 2001 and 2002.

	REDIMER study	Euroaspire Spain 2001 ^a	Premise 2002 [6]	Presenciap 2001 [13]	Elipse study 2000 [11]	Romera et al. 2002 [14]
Design	Cross-sectional	Prospective	Prospective	Cross-sectional	Cross-sectional	Cross-sectional
Setting	PC	H	PC	PC	PC	PC
No. of patients	1030	404	486	183	205	64
Follow-up period		6 months	2 years
LDL < 100 mg/dl	30.9%				9%
LDL < 130 mg/dl	72%			22.4%	30%
TC < 200 (5 mmol/l)		47%	46%
BP > 140/90 mmHg	31.9%	49.4%	41%		51.7%
Obesity	37.5%	34.1%	19%	30%
Antiaggregants/anticoagulants	AG 76.8% AC 8.2%	AG 85.6 AC 6.2%	87%	49.7%		86%
Beta-blockers	48.5	47.3%	50%	22.4%		32.8%
Hypolipidaemic agents	65.3%	64.6%	52%		45.85%	Angor 50%
ACEs/ARBs	ACEs 37.7 ARBs 8.1%	21.8%	32%	24%		AMI 53.1%

^a Spanish cohort of Euroaspire study.

PC: primary care; H: hospital outpatient clinic; TC: total cholesterol; BP: blood pressure; AG: antiaggregants; AC: anticoagulants; ACEs: angiotensin-converting enzymes; ARBs: angiotensin II receptor blockers; AMI: acute myocardial infarction.

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