Comparison of secondary prevention in coronary heart disease patients living in rural and urban areas

OBJECTIVE
The aim of the present study was to assess differences between urban and rural patients with coronary heart disease (CHD) with respect to secondary prevention.

METHODS
This cross-sectional study included all consecutive patients diagnosed with CHD at 2 cardiology clinics between January 2016 and January 2017. The demographic characteristics and laboratory parameters were recorded at routine control visits. The patients were divided into 2 groups according to residence based on their statements: urban (n=1752) and rural (n=456).

RESULTS
The median age of the patients was 64 years (interquartile range: 12 years). A mean of 4.1±2.1 years had passed after the first (index) coronary event. It was determined that 22.2% of the patients continued to smoke. The rate of quitting was significantly higher in the urban group (20.5% vs. 11.2%; p<0.001). The presence of hypertension (64.3% vs. 56.7%), diabetes mellitus (45.6% vs. 39.2%), cerebrovascular events (9.2% vs. 3.8%), and chronic obstructive pulmonary disease (11.4% vs. 5.5%) was significantly greater among the rural patients (p<0.05 for each). In all, 34.2% were obese, and the number of obese patients was significantly greater among the rural patients (46.4% vs. 31.2%; p<0.001). The number of patients performing regular exercise was significantly lower in the rural patient group (34.4% vs. 23.9%; p<0.001). Overall, 88.9% of the patients were taking antiplatelet agents, 62.1% were taking statins, 73.1% were taking beta-blockers, and 34.2% were taking ACEI/ARB. The rate of medication use was significantly greater among urban patients compared with rural patients (p<0.05 in all cases).

CONCLUSION
Secondary prevention efforts among patients with CHD require additional improvement. Moreover, secondary prevention is currently less successful among the rural population than the urban population.