Dependence of blood pressure control rate on the level of healthcare system where the hypertensive patient is treated

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Abstracts

from 75% to 100% (p = 0.000). There were no significant differences in the compliance rates for stress test, coronary angiogram, lipid profile determination and 2D echocardiogram in both studies. In the PINAS I Study, the usage rates of beta-blockers, ACE inhibitors, statins, nitrates, aspirin, clopidogrel and anticoagulant were 84.8%, 70%, 89.2%, 97.5, 60%, 50%, and 90% which became 86.9%, 70.4%, 93.9%, 86.9%, 72.1%, 40% and 92% respectively in PINAS II. Conclusion: Compliance rates to many class I recommendations (especially the non-invasive interventions) were high and did not differ significantly in both studies. PINAS II maintained the low in-hospital mortality rate (2.6%) which PINAS I (Phase III) previously demonstrated. No significant differences were also seen in total hospital and ICU stay. doi:10.1016/j.ijcard.2009.09.301 IG000132 Blood pressure management: translating evidence into practice in Australia NANCY HUANG National Heart Foundation of Australia, Australia Objective: Hypertension contributes to 8% of the burden of disease in Australia. Approximately 30% of the population (~3.7 million) have a diagnosis of or are on treatment for hypertension. However, only about a third are appropriately managed to minimise their risk for cardiovascular disease. This ‘management gap’ contributes to the ongoing burden of cardiovascular disease in Australia. The Heart Foundation of Australia has developed national guidelines to reduce this management gap. We are also committed to tackling the inequalities in health outcomes faced by Aboriginal and Torres Strait Islander populations. Design and methods: Around 85% of the population visits a family doctor (GP) at least once in a year. Hypertension is the most commonly managed problem by a GP, and provides an ideal setting for evidence based care. Clinical guidelines provide recommendations for the care of individuals by health professionals, based on the best available evidence. But guidelines vary in quality and relevance, and its usefulness is measured by how well it has been or can be adopted into practice. Internationally, there is a growing body of evidence in effective knowledge translation strategies, and the National Heart Foundation is integrating this into the current policy and clinical practice environment in Australia. Results and discussion: Using hypertension management as a case study, a multi-faceted approach is required for improved care, including quality guideline development processes, policy and systems support, improved workforce capacity, data collection, quality improvement mechanisms, community education and access to resources. We do not act alone in this, and these actions need to be underpinned by strategic alliances with both government and nongovernment agencies. A discussion of how the National Heart Foundation is working to progress this broad agenda in Australia will be presented. doi:10.1016/j.ijcard.2009.09.302

IG000145 Are we doing sufficiently to follow guidelines? V. DZERVEa, A. LEJNIEKSb, A. ERGLISa a Research Institute of Cardiology, University of Latvia, Latvia b Clinic of Internal Medicine, P. Stradins University, Latvia Objectives: To analyze the prevalence, awareness and treatment of hypertension in Latvia during 12 years and to answer the question on how the management of hypertension corresponds to the Guidelines of European Society of Hypertension/European Society of Cardiology. Methods: 6 survey analysis: 2 population based randomized cross-

sectional epidemiological surveys (PBS) (5,320 participants), 3 patient cohort surveys selected from the General Practitioner (GP) offices (15,056 participants, 9,467 women, 5,589 men) and 1 coronary heart disease (CHD) patient cohort (EUROSPIRE III survey: 1,012 participants, 383 women, 790 men). Studies were performed from 1995 to 2007 year. Results: The leading risk factors are: smoking 19,8%, diabetes mellitus 18,7%, dyslipidemias 53,3%, and elevated blood pressure 48,1%. Prevalence of hypertension in PBS: 44% (47–50% men, 35–40% women), in GP patient cohort 48% and 54,5% in CHD hospital patients. Awareness of hypertension in PBS is between 65 and 74% depending on age/gender group, in GP patient cohort between 60 and 66%, and in hospital patient group undetected hypertension is 14,9% (5,3%woman, 20,6% men). Control of hypertension in PBS is between 9,5% and 16,5%, in GP patient groups 35%, and hospital patient group 30,7%. Antihypertension medication was received in 67,4% (average of all surveys) of hypertensives (79,2% women, 61,2% men). 51,8% of patients use ACE inhibitors, 35,2% beta-adrenoblockers, 31,3% Ca channel blockers, 37,5% diuretics and 6,2% angiotensin II receptor antagonists. Combined therapy was (2 and more medications) received in 68,3% of patients (71,1% men, 66,8% women). Conclusions: To analyze the situation, it is important to take into account the population based as well as the patient cohort studies. Our results support that our physicians follow the existing Guidelines of Hypertension management. Nevertheless, the gap exists between prevalence of risk factors, control of hypertension and our skills. The increase of hypertension awareness is needed. doi:10.1016/j.ijcard.2009.09.303 IG000200 Dependence of blood pressure control rate on the level of healthcare system where the hypertensive patient is treated DIMITRA KALIMANOVSKA OSTRIC, DRAGANA ZANFIROVIC, BRANISLAVA IVANOVIC Institute for Cardiovascular Diseases, Clinical Center of Serbia, Serbia Objective: Evaluation of the influence of strict adherence to the National Guidelines for Diagnosis and Management of Arterial Hypertension (HTA), based on the European Guidelines, upon the success rate of blood pressure control in patients treated at different levels of the healthcare system in our country. Design and methods: Prospective, follow-up study of randomly chosen 180 patients (80 women and 100 men, mean age 60 years) with the diagnosis of first or second grade HTA. They were divided into 3 equal groups, according to the level of healthcare system where the patient was examined and antihypertensive treatment initiated and modified. Group I referred to patients treated in the primary care center in Kosovo Polje, Group II in the secondary level hospital in Laplje Selo and Group III in our institute as a representative of the tertiary level of the healthcare system. The patients were completely examined at the beginning and every 3 months during the 9 months of follow-up in order to diagnose, assess the severity and complications of HTA and evaluate the success of treatment. Results: There was no statistically significant difference of HTA severity between the groups before treatment (x2 =4,727; p>0,05). There was statistically significant lowering of both systolic (F=3,260; p<0,05) and diastolic blood pressures (F=1,933 p<0,05) during the follow-up period. The blood pressure control rate was achieved in 55,6% patients. The difference in blood pressure control rates between the examined groups was not statistically significant (x2 =2,340; p>0,05). Conclusion: Implementation of contemporary guidelines for diagnosis and management of hypertension by physicians achieves similar blood pressure control rate and success of antihypertensive treatment irrespective of the institutions within the healthcare system where the compliant patients with mild–moderate arterial hypertension are treated. doi:10.1016/j.ijcard.2009.09.304