Risk-factor control and secondary prevention in ischaemic heart disease in primary care: real-world insights from QregPV

Abstract

Aims: With current, stricter lipid and blood pressure targets in patients with ischaemic heart disease (IHD), secondary prevention may be insufficient and vary between patient groups and primary health care centres (PHCCs). We assessed the heterogeneity of risk-factor control and secondary prevention using contemporary Swedish primary-care data. Methods and results: Cross-sectional study of IHD patients in September 2023 from QregPV, a Swedish regional primary-care register. We evaluated the proportions attaining risk-factor control [blood pressure <140/90 mmHg, LDL-cholesterol (LDL-C) < 1.4 mmol/L, and non-smoking] and the use of lipid-lowering therapy (LLT) and antithrombotic therapy (ATT) by age and sex using logistic regression models. Heterogeneity among PHCCs was estimated using multilevel models and summarized as adjusted median odds ratios (aMOR). Here 45 771 patients (34.5% women) were included. Combined risk-factor control was low, 15.5% (95% CI 15.0–16.0), mainly due to low LDL-C attainment, 20.7% (20.3–21.1). Combined risk-factor control decreased with higher age (P < 0.001) and was lower in women than in men, age-adjusted odds ratio (aOR) 0.60 (0.55–0.66). LLT and ATT were used by 77.2% (76.8–77.6) and 85.6% (85.2–85.9), with lower usage in women, aOR 0.52 (0.50–0.54) and aOR 0.58 (0.54–0.62). Substantial heterogeneity among PHCCs was observed, with combined risk-factor control aMOR 1.39 (1.32–1.48). Conclusion: Combined risk-factor control was low, largely due to low LDL-C control, despite high LLT usage. Risk-factor control and the use of LLT and ATT varied between PHCCs and were lower in women than men. Concrete clinical strategies for attaining risk-factor goals in both sexes and for reducing PHCC variation are warranted.