Poor long-term cardiovascular risk factor management after acute coronary syndrome: An observational cohort study.

Abstract

Cardiovascular risk factor control reduces the risk of recurrent events after acute coronary syndrome (ACS). Long-term post-ACS management is poorly studied. To assess frequency of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP) monitoring and target achievement during 3 years post-ACS. Data from all patients hospitalized for ACS in Uppsala between 2012 and 2020 were obtained from electronic health records (EHRs). The probability of measurement and target achievement was estimated with adjusted regression models. Associations were assessed for sex, participation in cardiac rehabilitation (CR), presence of diabetes with nurse-led follow-up and documentation of an ICD-10 code for chronic ischaemic heart disease in the EHR. Among 6083 patients (median age 73 years, 34% female), follow-up data were available for 72% in year 1, 56% in year 2 and 44% in year 3. Year 3 LDL-C was not measured in 48% of patients, and 19% were at target (<1.8 mmol/L). For SBP, 16% lacked a measurement, and 50% were at target (<140 mmHg). Female sex was associated with lower probability of having LDL-C measured or having LDL-C or SBP at target. CR participation, structured diabetes follow-up or having a chronic ischaemic heart disease code in the EHR was associated with a higher probability of LDL-C and SBP measurements at 2 and 3 years. Lack of measurement and low risk factor achievement highlight missed opportunities in secondary prevention. Female sex, lack of structured follow-up and the absence of diagnostic labelling were associated with less frequent monitoring and poorer risk factor control.