Abstract

Objective. To determine longitudinal changes in lifestyle behaviour and lipid management in a chronic coronary heart disease (CHD) population. Design. A multi-centre cohort study consecutively included 1127 patients at baseline in 2014–2015, on average 16 months after a CHD event. Data were collected from hospital records, a questionnaire and clinical examination. Seven hundred and seven of 1021 eligible patients participated in a questionnaire-based follow-up in 2019. Data were analysed with univariate statistics. Results. After a mean follow-up of 4.7 years (SD 0.4) from baseline, the percentage of current smokers (15% versus 16%), obesity (23% versus 25%) and clinically significant symptoms of anxiety (21% versus 17%) and depression (13% versus 14%) remained unchanged, whereas the proportion with low physical activity increased from 53% to 58% (p < .001). The proportions with reduced physical activity level were similar in patients over and under 70 years of age. Most patients were still taking statins (94% versus 92%) and more patients used high-intensity statin (49% versus 54%, p < .001) and ezetimibe (5% versus 15%, p < .001) at follow-up. 73% reported ≥1 primary-care consultation(s) for CHD during the last year while 27% reported no such follow-up. There were more smokers among participants not attending primary-care consultations compared to those attending (19% versus 14%, p = .026). No differences were found for other risk factors. Conclusions. We found persistent suboptimal risk factor control in coronary outpatients during long-term follow-up. Closer follow-up and intensified risk management including lifestyle and psychological health are needed to improved secondary prevention and outcome of CHD.

Trial registration: Registered at ClinicalTrials.gov: NCT02309255.

Registered at 5 December 2014, registered retrospectively.

摘要

客观的。确定慢性冠心病 (CHD) 人群生活方式行为和血脂管理的纵向变化。设计。一项多中心队列研究连续纳入了 2014-2015 年基线时的 1127 名患者，平均在 CHD 事件发生后 16 个月。数据来自医院记录、问卷调查和临床检查。2019 年，1021 名符合条件的患者中有 707 名参加了基于问卷的随访。数据采用单变量统计分析。结果。从基线开始平均随访 4.7 年 (SD 0.4) 后，当前吸烟者（15% 对 16%）、肥胖（23% 对 25%）和有临床意义的焦虑症状（21% 对 17%）的百分比和抑郁（13% 对 14%）保持不变，而低体力活动的比例从 53% 增加到 58% ( p  < .001)。在 70 岁以上和 70 岁以下的患者中，体力活动水平降低的比例相似。大多数患者仍在服用他汀类药物（94% 对 92%），更多患者使用高强度他汀类药物（49% 对 54%，p  < .001）和依折麦布（5% 对 15%，p < .001) 在随访中。73% 的人报告在过去一年中进行了 ≥ 1 次 CHD 初级保健咨询，而 27% 的人报告没有此类随访。与参加初级保健咨询的参与者相比，未参加初级保健咨询的参与者中吸烟者更多（19% 对 14%，p  = .026）。其他风险因素没有发现差异。结论。我们发现在长期随访期间，冠状动脉门诊患者的危险因素控制持续欠佳。需要更密切的随访和强化风险管理，包括生活方式和心理健康，以改善冠心病的二级预防和结果。

试验注册：在 ClinicalTrials.gov 注册：NCT02309255。

2014 年 12 月 5 日登记，追溯登记。