Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes. Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods. Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation. Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world. Data may be obtained from a third party and are not publicly available. The data are not available for public use, though the authors invite requests from outside scientific groups to collaborate on analyses of the dataset.

中文翻译：

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二级预防中的医院间和个体间差异：有慢性冠脉综合征病史的门诊患者与有急性冠脉综合征病史的门诊患者的比较（iASPIRE 研究）

背景 研究为二级预防冠心病 (CHD) 门诊患者提供的护理的可变性可以确定改善其结果的干预措施。方法 我们研究了在过去 6-24 个月内发生过一次 CHD 事件的门诊患者。符合条件的 CHD 事件包括急性冠状动脉综合征 (ACS) 和稳定慢性冠状动脉综合征 (CCS) 的冠状动脉血运重建。现场培训由核心团队提供，并使用标准化方法收集数据。结果 2017 年至 2019 年间，我们在爱尔兰的 9 个研究地点招募了 721 名门诊患者；81% 为男性，平均年龄为 63.9 (SD ±8.9) 岁。研究检查发生在指数 CHD 事件后 1.16 年，其中 399 名参与者 (55%) 为 ACS，322 名参与者为稳定-CCS。检查时，42.5% 的参与者血压 (BP) >140/90 mm Hg， 63. 7% 的低密度脂蛋白胆固醇 (LDL-C) >1.8 mmol/L，44.1% 的已知糖尿病患者 HbA1c >7%。风险因素控制存在显着差异，无论是根据研究地点，还是特别是指数呈现类型。例如，82% 的既往 ACS 门诊患者参加过心脏康复治疗，而 59% 的既往 CCS 门诊患者（p<0.001）在控制 LDL-C 等传统危险因素（p=0.002）和以既往 ACS 与既往 CCS 门诊患者的收缩压 (p<0.001) 为指标。结论 尽管国际二级预防指南广泛推荐所有 CHD 成人的危险因素目标，我们发现根据医院位置和指标 CHD 表现类型（急性与慢性），门诊风险因素控制和管理存在显着差异。这些发现强调需要减少预防性护理中医院层面和患者层面的变异性以改善结果；这一课应该为爱尔兰和世界各地的冠心病预防计划提供信息。数据可能从第三方获得，并且不公开。尽管作者邀请外部科学团体的请求合作分析数据集，但这些数据不可供公众使用。数据可能从第三方获得，并且不公开。尽管作者邀请外部科学团体的请求合作分析数据集，但这些数据不可供公众使用。数据可能从第三方获得，并且不公开。尽管作者邀请外部科学团体的请求合作分析数据集，但这些数据不可供公众使用。