BackgroundEffective management of cardiovascular risk factors is the foundation of secondary prevention in coronary artery disease. The physician under whose sphere these are managed can vary, primary care physicians, cardiologists, or both, and the optimal management strategy for risk factor control is unknown.Methods and ResultsThe APPEAR (Angina Prevalence and Provider Evaluation of Angina Relief) study was a cross‐sectional cohort study of outpatients with coronary artery disease (stable angina, percutaneous coronary intervention, coronary artery bypass grafting, or myocardial infarction) from 25 US cardiology practices. After each patient visit, providers noted who managed each risk factor. Blood pressure and lipid levels were recorded from charts. We compared adherence to guideline‐directed risk factor control between management strategies (primary care physician alone, cardiologist alone, or comanaged). Among 1259 outpatients with coronary artery disease (mean [SD] age, 71 [11.1] years; 69% men), blood pressure and lipid management strategy varied. Mean blood pressure was 127.9/72.3 mm Hg, with 74% of patients at <140/90 mm Hg and 46% at <130/80 mm Hg. Mean low‐density lipoprotein was 83.5 mg/dL, with 75% of patients at <100 mg/dL and 91% on appropriate statin therapy. Patients managed by cardiologists alone tended to have higher rates of risk factor control for both blood pressure and lipids, even after adjusting for covariates.ConclusionsAlthough comanagement has shown benefit in some clinical situations, we found that risk factor control in patients with coronary artery disease tended to be poorer when care was shared between cardiologists and primary care physicians. Further research is needed to better define which conditions are best comanaged and how to more effectively comanage patients in the fractured US healthcare system.

中文翻译：

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合并冠状动脉疾病患者的危险因素：APPEAR研究的见解。

背景心血管疾病危险因素的有效管理是冠心病二级预防的基础。方法和结果在APPEAR（心绞痛患病率和提供者评估）中是交叉的，方法和结果未知。 25例门诊冠心病患者（稳定型心绞痛，经皮冠状动脉介入治疗，冠状动脉搭桥术或心肌梗塞）的分组研究我们心脏病学实践。每次患者就诊后，提供者均应指出谁负责管理每个风险因素。从图表记录血压和血脂水平。我们在管理策略（仅初级保健医师，仅心脏病专家或共同管理）之间比较了依从性和指南风险因素控制。在1259例冠心病门诊患者中（平均[标清年龄71 [11.1]岁；69％的男性），血压和血脂管理策略各异。平均血压为127.9 / 72.3 mm Hg，其中74％的患者<140/90 mm Hg，46％的患者<130/80 mm Hg。平均低密度脂蛋白为83.5 mg / dL，其中75％的患者<100 mg / dL，91％的患者接受适当的他汀类药物治疗。即使在校正协变量后，仅由心脏病专家管理的患者往往对血压和血脂的危险因素控制率也较高。结论尽管在某些临床情况下协同治疗已显示出益处，但我们发现对冠心病患者的危险因素控制趋于在心脏病专家和初级保健医生之间共享护理时会变得更贫穷。我们 医疗系统。