292 Management of stable coronary artery disease patients: Very efficient for a population but probably insufficient for every single patient. The Indyce survey.

Background: In studies and surveys involving stable coronary artery disease (CAD) patients, the global population often seems well managed; however, the question remains to know what is the proportion of patients who benefit from every simple medical intervention improving the prognosis or showing good quality of care. Objective: To evaluate medical management of stable CAD outpatients in France by calculating a progressive quality index. Methods and Results: The INDYCE survey was conducted in a sample of 343 cardiologists in France in 2008. Each physician had to include consecutively 10 stable CAD patients (absence of acute coronary syndrome or revascularisation in the 6 months preceding enrolment). 3119 patients (male: 80%, 68±11 years old, diabetes: 24.3%, hypertension: 61.6%) were enrolled. Medical therapy was in keeping with Guidelines (antiplatelet agents (AA) : 88.4% ; statins : 85.9% ; ACE-I/ARBs : 78.8%, beta-blockers (BB) : 74.6%). Patients suffered from mild to moderate symptoms (angina : 19.2%, NYHA class 0 or I : 43.5%, NYHA class II : 46.9%, NYHA class III : 9.3% ; NYHA class IV : 0.3%). Mean rest heart rate (HR) was of 64.2±10.8 bpm, mean systolic and diastolic blood pressure (BP) of 131.8±15.4 and 75.8±8.4 mmHg respectively. However, when calculating a progressive quality index: [(1)] 44.69% of the patients received an AA + a statin + an ACE-I/ARBs + a BB [(2)] 29.79% had (1) and a systolic BP < 140 mmHg + a diastolic BP < 90 mmHg [(3)] 23.02% had (1) + (2) and a resting heart rate < 70 bpm [(4)] 12.6% had (1) + (2) + (3) and had a regular physical activity [(5)] 6.96% had (1) + (2) + (3) + (4) and had performed an exercise test during the last 12 months [(6)] 4.07% had (1) + (2) + (3) + (4) + (5) and were asymptomatic (no angina and NYHA class 0 or I) Conclusion: Stable CAD patients do not raise attention because they are often pauci-symptomatic. At a population level, they appear to be well managed. However, building a quality index allows us to show that very few of these patients benefit from every step of a simple medical management. [Copyright &y& Elsevier]