A collective failure of medical practice?

The European Society of Cardiology has launched an ambitious programme of 11 surveys to monitor the quality of management of various forms of cardiovascular disease in Europe. They span the gamut of heart failure to stroke. The results of the first of these Euro Heart Surveys, directed at the management of prevention of recurrence of coronary artery disease, are reported in this issue. The authors of the report conclude that we, as European cardiologists, are not living up to the standards of treatment that were developed and adopted, only 2 years ago, by the ESC in an alliance with other major European scientific societies. Not mincing their words, the authors conclude that the survey shows ‘that integration of coronary heart disease prevention into daily practice is inadequate, reflecting a collective failure of medical practice’. Is that a fair conclusion? The survey, called EUROASPIRE II (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), is a logical extension of an earlier European survey (EUROASPIRE I), published 3 years ago, but the methodology also reflects that of an American study, as yet not published in a definitive form. It is, moreover, a good example of a follow-up of a process of formulation and implementation of recommendations for the secondary prevention of coronary heart disease in Europe. For the purposes of the EUROASPIRE II survey, David Wood and his colleagues identified clusters of hospitals, serving specified geographical areas, each with more than half a million inhabitants in 15 countries across Europe. One of the hospitals was a university hospital with interventional cardiology and cardiac surgery, and one or more were associated general hospitals that received patients with acute myocardial infarction or acute myocardial ischaemia. More than 8000 medical records were reviewed, and 5556 consecutive patients were interviewed and examined at least half a year after the event that qualified them for entry. With substantial variation between countries, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty,