More studies of note
PARIS -- Do patients comply with their prescribed medication course following heart surgery? The answer is yes -- but not for long, according to 8-year results from the SWEDEHEART trial reported at the European Society of Cardiology meeting here.
Other findings of note covered the prognostic value of angina in coronary artery disease among MI survivors; long-term risks from physical inactivity; and awareness of driving restrictions for recipients of implantable cardioverter defibrillators (ICDs).
Preventive medication use is generally high shortly after coronary artery bypass graft, but that doesn't last long as time passes, SWEDEHEART investigators found.
Nearly 94% of patients had statins dispensed to them during the 6 months following discharge from surgery, falling to about 77% after 8 years. Similar declines were reported for other drugs from 6 months after surgery to 8 years: from 91% to 76% for beta-blockers, from 93% to 80% for antiplatelets, and from 73% t0 66% for renin-angiotensin-aldosterone system (RAAS) inhibitors.
After adjusting for sex, age, comorbidities, and use of other prevention drugs, adherence to platelet inhibitors was linked to a 26% lower relative risk of mortality. Moreover, RAAS inhibitors and statins were also significantly linked to 22% and 44% lower mortality, respectively.
Most important, perhaps, the total time using platelet inhibitors, RAAS inhibitors, and statins was associated with significantly lower mortality, although this was not the case for beta-blockers.
Angina was associated with poor outcomes in MI survivors with stable coronary artery disease, according to CLARIFY registry data.
Among roughly 33,000 patients in 45 countries, MI survivors without angina were significantly less likely to suffer another nonfatal MI or cardiovascular death over 5 years when compared to those with angina (8.2% vs 11.8%). For patients without prior MI, event rates were comparable and lower irrespective of angina (6.3% with angina vs 6.4% without).
Study authors suggested the CLARIFY data could be helpful in managing this patient population and guiding future investigations.
Individuals who were physically inactive when assessed during 1984-1986 and again during 2006-2008 had greater risk of CVD death (HR 2.68, 95% CI 1.47-4.86) and all-cause death (HR 1.99, 95% CI 1.48-2.67) when compared to people who were physically active for 2 hours per week during both time periods.
HUNT participants who reported some physical activity at the first assessment but were inactive at the second showed long-term mortality risks similar to those who were inactive at both assessments.
Driving with an ICD
A Danish nationwide survey study found that many ICD recipients -- including cab drivers and other driving professionals -- did not know about the mandatory driving restriction and continued driving when they shouldn't have.
Just 64% of secondary prevention patients, 45% of professional drivers, 72% of patients who faced an appropriate ICD shock, and 43% of primary prevention patients remembered being told of any driving restrictions.
Even among those who recalled being told about the restrictions, 20%-30% of the ICD recipient groups said they drove anyway during the restricted period, which in Denmark is 3 months for secondary prevention, 1 week for primary prevention, and 3 months after receiving an appropriate shock.
ICD recipients are banned permanently from driving professionally. Still, more than 20% of professional drivers who knew about the restriction said they continued to drive.
Read the original article on Medpage Today: ESC Roundup: SWEDEHEART, CLARIFY, HUNT