Integrated cardiovascular risk management in primary care

Abstract

Integrated cardiovascular risk management (CVRM) programmes in primary care might improve cardiovascular disease (CVD) prevention. We investigated the effect of integrated CVRM care compared to usual care within general practices among patients with known CVD or at high CVD risk. After one year we observed no difference in blood pressure (BP) or LDL-cholesterol levels nor in calculated 10-year cardiovascular risk, overweight, lifestyle, medication use, patient satisfaction, healthcare consumption, morbidity, comorbidity and mortality. To better understand these disappointing results we evaluated the CVRM care that was actually delivered, and assessed patients’ perception of cardiovascular risk and lifestyle advice. In total, 85% intervention and 32% usual care patients received at least one consultation, including measurements of BP, weight, LDL-cholesterol and renal function. In patients with a BP or LDL-cholesterol above the target, medication was changed in 57% and 9% of the cases. Less than a quarter of patients correctly estimated their cardiovascular risk. Less than one-third of patients who received lifestyle advice reported having received the advice. Furthermore, we evaluated the effect of the CVRM programme on hospital care. It appeared that two years after the start of the programme, the median length of treatment at the hospital and the total median costs of CVRM related hospital care per patient decreased. Finally, we found that in another primary care population in 93% of patients with dyslipidaemia, CVD or diabetes mellitus the general practitioner did not change the lipid-lowering drugs, despite an elevated LDL-cholesterol. There are plenty of challenges for CVRM care.