Abstract 1593: Failure to Optimise Therapy in Angina Pectoris
Background: In the management of chronic stable angina (CSA), percutaneous coronary intervention (PCI) provides symptomatic relief of angina rather than improve prognosis. Current guidelines therefore recommend optimisation of medical therapy prior to elective PCI.
Methods:The FORGET Audit Study is a multi-centre audit of case records of patients undergoing elective PCI for chronic stable angina, involving 6 hospitals. Data collected included optimisation of drug therapy and achieved targets in lipid levels, resting HR and blood pressure (BP).
Results: A total of 468 case records of patients [73% male; mean age 63.85±9.8(SD) yrs] were analyzed. Close to all patients (98.8%) were receiving antiplatelet therapy. For secondary prevention, 91% were receiving a statin and 73 % were on an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. In terms of medical anti-ischaemic therapy, 84.8 % were on beta-blockers [mean or equivalent dose of bisoprolol was 3.78 mg (range 1.25mg to 10 mg)], 11% were on a rate limiting calcium antagonist, 28% on a nitrate or nicorandil and one patient was receiving ivabradine. Mean total cholesterol was 4.4±1.1 mmol/l, mean systolic BP of 130±25 mmHg and mean diastolic BP of 70±14 mmHg. Serum cholesterol was < 5 mmol/l in 76% of patients and <4mmol/l in 38%, 65% of patients had systolic BP < 140mmHg and 95% had diastolic BP < 90mmHg. A large proportion of patients did not achieve target resting HR; 27.2 % of patients had a resting HR of > 70 bpm, 30.8% had a resting HR between 60 –70 bpm and 29% had a resting HR between 51– 60 bpm. The resting HR was not related to the dose of betablocker: mean equivalent doses of bisoprolol were 3.3±2.3 mg (HR<50 bpm); 3.8±2.4 mg (HR 51– 60 bpm); 3.8±2.4 mg (HR 61–70 bpm) and 4.1±3.3mg (HR > 70 bpm) (p=0.54). BP was similar across the different HR groups: Systolic BP: 127±24 mmHg (HR<50 bpm); 129±23 mmHg (HR 51– 60 bpm); 131±23 mmHg (HR 61–70 bpm); and 131±29 mmHg (HR>70 bpm) (p=0.56).
Conclusions: A significant proportion of patients with CSA are not reaching therapeutic targets for lipid and blood pressure control prior to referral for elective PCI with 50% of patients not receiving adequate HR lowering therapy to achieve recommended targets.