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ESC Guidelines on prevention and rehabilitation in coronary heart disease and current practice: the EUROASPIRE VI survey

D.R. WoodCroíCatriona JenningsNational Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre Moyola Lane , Newcastle, Galway, Co. Galway, H91 FF68 ,Kornelia KotsevaNational Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre Moyola Lane , Newcastle, Galway, Co. Galway, H91 FF68 ,Agnieszka AdamskaNational Institute for Prevention and Cardiovascular Health, Croi Heart and Stroke Centre Moyola Lane , Newcastle, Galway, Co. Galway, H91 FF68 ,Iris ErlundInstitute for Nutrition and Health Research , Kivihaantie 7, Helsinki ,Sandra GanlyCroíPer‐Henrik GroopDepartment of Diabetes, Central Medical School , Melbourne, Victoria ,Susan HennessyCroíMaarten J.G. LeeningErasmus University RotterdamLinda MellbinDepartment of Cardiology, Karolinska University Hospital , Eugeniavägen 27, Solna Stockholm 17164 ,Kausik K. RayImperial College LondonLars RydénDepartment of Medicine, Solna Cardiology, Karolinska Institutet , Eugeniavägen 27, Solna Stockholm 17164 ,Terhi VihervaaraInstitute for Nutrition and Health Research , Kivihaantie 7, Helsinki ,Victor AboyansEpiMaCT research group, INSERM1094/IRD270, Limoges University , 25 Rue Marcland, Limoges 87025 ,Ana AbreuCardiovascular Rehabilitation Unit, Cardiology Service, Hospital S. Maria (ULSSM); ISAMB, CAML, School of Medicine, University of Lisbon, Av. Professor Egas Moniz , Lisbon (1649-028) ,Carlos AguíarCardiology, Hospital Santa Cruz (ULSLO), Av. Prof. Reinaldo dos Santos , Carnaxide 2790-134 ,Karl AndersenNational University Hospital of IcelandJolita BadarienėClinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,Jan BruthansCenter for Cardiovascular Prevention, Thomayer University Hospital , Vídeňská 800, (Prague 4), Prague 140 59 ,Monika BurzyńskaSuccessful Ageing Research Unit, Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education , Czerniakowska 231, Warsaw 00-416 ,Almudena Castro CondeCardiology Cardiac Rehabilitation Unit, La Paz University Hospital , Paseo de la Castellana 261, Madrid 28046 ,Renata CífkováDepartment of Medicine II, Charles University in Prague, First Faculty of Medicine , U nemocnice 2, Prague 128 08 ,Furio ColivicchiEmergency Department, Clinical and Rehabilitation Cardiology, San Filippo Neri Hospital , Via Martinotti, 20 - 00135 Rome ,Kairat DavletovScience Technology Park, Asfendiyarov Kazakh National Medical University , 94 Tole Bi street, Almaty ,Mirza DilićInstitute of Metrology of Bosnia and HerzegovinaElena DimitrovaCardiology, National Heart Hospital , Konyovitsa 65 Str., Sofia 1309 ,М. М. ДолженкоState Institution «National scientific center «Institute of Cardiology, Clinical and Regenerative Medicine named after academician M.D. Strazhesko , Sviatoslava Khorobroho 5, Kyiv 3151 ,Vilnis DzērveInstitute of Cardiology and Regenerative Medicine, Faculty of Medicine and Life Sciences of the University of Latvia , 13 Pilsonu str., Riga LV1002 ,Andrejs ĒrglisPauls Stradins Clinical University Hospital, University of Latvia , Pilsonu Street 13, Riga, LV1002 ,Zlatko FrasChair of Internal Medicine, Cardiology & Vascular Medicine, Medical Faculty, University of Ljubljana , Vrazov trg 2, Ljubljana SI-1000 ,Barış GüngörSağlık Bilimleri ÜniversitesiPeter U. HeuschmannInstitute for medical Data Sciences, University Hospital Würzburg , Am Schwarzenberg 15, Würzburg, Bavaria 97078 ,Piotr JankowskiDepartment of Epidemiology and Population Health, School of Public Health, Centre of Postgraduate Medical Education , Kleczewska 61/63, Warsaw Mazowsze 01-826 ,Iulia KulcsarICU Medical Director, Institute for CVD Emergencies “Prof.Dr.C.C.Iliescu” , 258 Fundeni way, Bucharest Sector 2, 22328 ,Nebojša LalićFaculty of Medicine University of Belgrade , Dr Subotica 8, Belgrade 11000 ,Seppo LehtoInternal Medicine, Lapland Central Hospital and Oulu University , Ounasrinteentie 22, FI-96400 Rovaniemi ,Dragan LovićUniversity Singidunum, School of Medicine, Outpatient Clinic for internal Disease Intermedica , Danijelova 32, Belgrade 11000 ,Aldo P. MaggioniANMCO Research Center, HCF Fondazione ANMCO per il Tuo Cuore ETS , Florence ,Fabrice M A C MartensAmsterdam University Medical CentersLampros K. Michalis2nd Department of Cardiology, School of Health Sciences,Faculty of Medicine, Division of Internal Medicine, University of Ioannina, University Campus Ioannina , GR 45110 ,Davor MiličićDepartment of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb School of Medicine , Kispaticeva 12, Zagreb 10000 ,Erkin М МirrakhimovKyrgyz State Medical Academy , 92 Akhunbaev street, Bishkek 720020 ,Greg MurphyUniversity of Galway, University Road, Galway, Co , Galway, H91 TK33 ,Öner ÖzdoğanCardiology, University of Health Sciences, Izmir Medical Faculty, Izmir City Hospital , Refik Sevket Ince Mah. 2148/11 S. No: 1/11, Bayrakli/Izmir 35540 ,Jurgita PlisienėHeart Centre, Lithuanian University of Health Sciences , Eiveniu street 2, Kaunas 50161 ,Željko ReinerDepartment for Internal Diseases, University Hospital Centre Zagreb , Kispaticeva 12, Zagreb 10000 ,Stefan StörkDepartment of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg , Am Schwarzenberg 15, 97078 Würzburg ,Lâle TokgözoğluCardiology, Hacettepe University , Sıhhiye, Ankara 06230 ,Jamol UzokovCardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation , 4 Osiyo, Tashkent 100084 ,Duško VulićAcademy Science and Arts Republic of Srpska , Bana Lazarevica 1, Banja Luka 51000 ,Dirk De BacquerDepartment of Public Health and Primary Care, Epidemiology of Chronic Diseases Research Group, Ghent University , C. Heymanslaan 10–4K3, entrance 42, Ghent 9000 ,John W. McEvoyCOPE Galway

2026en

ABI

Аннотация

BACKGROUND AND AIMS: This observational study investigated whether patients with coronary heart disease (CHD) in Europe are achieving the standards set by prevention and rehabilitation guidelines. Variability was studied: (i) between countries; (ii) between geographical risk regions; and (iii) attendance at cardiac rehabilitation (CR) with outcomes. METHODS: Observational study between September 2024- February 2026 in 160 hospitals across 27 countries. Geographical risk regions were defined as high, moderate or low based on WHO cardiovascular mortality data. RESULTS: Among 8590 patients with CHD (23.7% female), 17.1% were current smokers, 32.0% were obese and 33.5% reported low physical activity. 59.8% were above blood pressure target (systolic ≥ 130 and/or diastolic ≥ 80 mmHg), 82.7% were above LDL-C target (≥ 1.4 mmol/l), 32.8% had known diabetes of whom 42.2% had HbA1c ≥ 7% and 30.6% had chronic kidney disease. Prevalences of these risk factors were all highest in countries from high risk regions. 29.1% of patients attended at least one CR session, with country variability ranging from 0% to 79%, and differing by risk region (55.9% low risk, 29.7% moderate risk and 10.2% high risk; p < 0.001). Attendance at CR programme was associated with significantly better lifestyles, risk factor control and use of cardioprotective drugs. CONCLUSIONS: Most European patients are not achieving targets set by prevention guidelines. There is marked variability in CR attendance, evidence of inverse care with lowest attendance in highest risk regions, despite better outcomes for CR. These results inform the challenges for implementation of the first ESC guideline on CR.

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DOI: 10.1093/eurheartj/ehag741

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