Stable angina pectoris: population trends, diagnostics, secondary prevention, and antianginal therapy

Aim. To assess compliance with international clinical guidelines on coronary heart disease (CHD) secondary prevention, as well as on stable angina pectoris diagnostics and treatment, in Russian clinical practice settings. Material and methods . Among 5000 randomly selected out-patients visiting Moscow City Cardiology Dispanser (MCCD) in 2001, 1840 patients with stable angina diagnosis were identified. Out-patient medical documents were studied, and information on CHD risk factor (RF) registration, clinical diagnosis, clinical and laboratory tests, therapy (agents and their doses), associated diseases and their treatment, was analyzed. Results. Moscow doctors, in spite of existing international and national clinical guidelines, do not use objective diagnostic tests and rely on subjective complaints, while assessing disease severity and determining management tactics, in every second patient (49.2%). The doctors inadequately address RF in stable angina patients, fail to modify RF effectively, and do not attain RF target levels. The principal problems of pharmacotherapy are inadequately low use of statins in CHD secondary prevention (1.8% at out-patient clinics; 6.4% Ц at MCCD), as well as use of minimal effective doses for most antianginal agents. Coronarography, coronary angioplasty, and bypass surgery rates are substantially lower than those in Eastern European countries. Conclusion. The recommendations of national and international guidelines on CHD secondary prevention, stable angina diagnostics and treatment, are still fulfilled inadequately.

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