Evaluation of 1-Year Follow-up of Patients Included in the Registry of Clinical Practice in Patients at High Cardiovascular Risk (REACT)

Abstract Background In clinical practice, there is evidence of failure to prescribe evidence-based therapies for patients at high cardiovascular risk. However, in Brazil, data on 1-year outcomes of these patients remain insufficient. Objectives To describe the use of evidence-based therapies and the occurrence of major cardiovascular outcomes and their major predictors in a 12-month follow-up of a Brazilian multicenter registry of patients at high cardiovascular risk. Methods This prospective observational study documented the outpatient clinical practice of managing patients over 45 years of age and of high cardiovascular risk in both primary and secondary prevention. Patients were followed-up for 1 year, and the prescription of evidence-based therapies and the occurrence of major cardiovascular events (myocardial infarction, stroke, cardiac arrest, and cardiovascular death) were assessed. P-values < 0.05 were considered statistically significant. Results From July 2010 to August 2014, a total of 5076 individuals were enrolled in 48 centers, 91% of the 4975 eligible patients were followed-up in cardiology centers, and 68.6% were in secondary prevention. At 1 year, the concomitant use of antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors reduced from 28.3% to 24.2% (p < 0.001). Major cardiovascular event rate was 5.46%, and the identified predictors were age, patients in secondary prevention, and diabetic nephropathy. Conclusions In this large national registry of patients at high cardiovascular risk, risk predictors similar to those of international registries were identified, but medical prescription adherence to evidence-based therapies was inferior and significantly worsened at 1 year. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

摘要
背景：临床实践中，已有证据表明心血管高风险患者未被开具循证治疗方案。但在巴西，此类患者1年随访结局的相关数据仍较为匮乏。
研究目的：旨在描述巴西一项多中心心血管高风险患者注册研究的12个月随访结果，包括循证治疗方案的使用情况、主要心血管不良事件的发生情况及其主要预测因素。
研究方法：本前瞻性观察性研究记录了年龄超过45岁、处于心血管高风险的门诊患者的临床诊疗实践，覆盖一级预防与二级预防人群。对所有入组患者进行为期1年的随访，评估循证治疗方案的处方情况以及主要心血管不良事件（包括心肌梗死、脑卒中、心脏骤停及心血管源性死亡）的发生情况。本研究以P值＜0.05作为具有统计学意义的判定标准。
研究结果：2010年7月至2014年8月期间，共计48个研究中心入组5076例受试者；在4975例符合纳入标准的患者中，91%在心脏科中心完成随访，68.6%的患者属于二级预防人群。随访至1年时，抗血小板药物、他汀类药物与血管紧张素转换酶抑制剂（angiotensin-converting enzyme inhibitors, ACEI）的联合用药比例从28.3%降至24.2%（P＜0.001）。主要心血管不良事件发生率为5.46%，已明确的预测因素包括年龄、二级预防人群及糖尿病肾病。
研究结论：在这项大型全国性心血管高风险患者注册研究中，虽发现了与国际注册研究相似的风险预测因素，但临床对循证治疗方案的处方依从性较差，且在随访1年时进一步显著恶化。（《Arq Bras Cardiol》[巴西心脏病学档案]. 2020; [网络预印版], 页码0-0）