Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland

Teppo Repo, Markku Tykkyläinen, Juha Mustonen, Tuomas T. Rissanen, Matti Ketonen, Maija Toivakka and Tiina Laatikainen
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Teppo Repo: Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland
Markku Tykkyläinen: Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland
Juha Mustonen: North Karelia Hospital District, 80210 Joensuu, Finland
Tuomas T. Rissanen: North Karelia Hospital District, 80210 Joensuu, Finland
Matti Ketonen: North Karelia Hospital District, 80210 Joensuu, Finland
Maija Toivakka: Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland
Tiina Laatikainen: North Karelia Hospital District, 80210 Joensuu, Finland

IJERPH, 2018, vol. 15, issue 4, 1-19

Abstract: Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients ( n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.

Keywords: secondary prevention; electronic medical records; coronary heart disease; primary care; quality of care; rural health; risk factors of CHD; geospatial health; health-care planning (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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