Randomised clinical trial of an intensive intervention in the primary care setting of patients with high plasma fibrinogen in the primary prevention of cardiovascular disease

AimThis study was designed to investigate primary prevention of cardiovascular disease in a primary care setting in Jordan.MethodsAdult patients without clinical cardiovascular disease who attended a primary care setting were interviewed and their medical files were reviewed. Data collected to assess primary prevention of cardiovascular disease included lifestyle/risk factor screening, weight assessment, blood pressure measurement and control, and blood lipid measurement and control.ResultsA total of 224 patients were interviewed. The proportions of patients’ files with risk factors documentation were 37.9% for smoking status, 30.4% for physical activity assessment and 72.8% for blood pressure assessment. The majority of hypertensive patients (95.9%) had a blood pressure reading at their most recent visit of ⩽140/90 or was prescribed ⩾2 antihypertensive medications.ConclusionDocumentation of cardiovascular disease risk factors was suboptimal. Healthcare providers should be encouraged to document and assess cardiovascular risk factors to improve primary prevention.

Download Full-text

Text messages for primary prevention of cardiovascular disease: The TextMe2 Randomised Clinical Trial

American Heart Journal ◽

10.1016/j.ahj.2021.08.009 ◽

2021 ◽

Author(s):

Harry Klimis ◽

Aravinda Thiagalingam ◽

Daniel McIntyre ◽

Simone Marschner ◽

Amy Von Huben ◽

...

Keyword(s):

Cardiovascular Disease ◽

Clinical Trial ◽

Primary Prevention ◽

Randomised Clinical Trial ◽

Text Messages ◽

Prevention Of Cardiovascular Disease

Download Full-text

Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02649-5 ◽

2021 ◽

Author(s):

Shi Ying Tan ◽

Heather Cronin ◽

Stephen Byrne ◽

Adrian O’Donovan ◽

Antoinette Tuthill

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Primary Care ◽

Primary Prevention ◽

Secondary Prevention ◽

Shared Care ◽

University Hospital ◽

Cross Sectional ◽

Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

Download Full-text

Abstract P720: Primary Stroke Prevention by Primary Care Providers: An Unmet Need

Stroke ◽

10.1161/str.52.suppl_1.p720 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Raymond Reichwein ◽

Alicia Richardson ◽

Cesar Velasco

Keyword(s):

Risk Factors ◽

Primary Care ◽

Primary Prevention ◽

Care Setting ◽

Stroke Risk ◽

Primary Care Setting ◽

Primary Care Providers ◽

Large Vessel ◽

Care Providers ◽

Stroke Risk Factors

Introduction: The majority of patients who present with acute ischemic stroke (AIS) have known stroke risk factors which are not optimally managed. It has been suggested that a CHADS-VASC score can assist with primary prevention by calculating future stroke risk. This however, has not been widely adapted in the primary care setting. Methods: From 2018-2019, 686 AIS patients were included in retrospective analysis. Data elements included: historical stroke risk factors, historical CHADS-VASC score, antiplatelet/anticoagulant use at time of presentation, discharge location, and mRS. Results: Of the 686 AIS patients, 77% were age > 60, and 52% were male. Etiology subtypes were small vessel/lacunar 20%, large vessel 22%, cardioembolic 20%, undetermined 31% (cryptogenic 15%), and other determined 5%. On presentation, the majority of patients had 2 or more stroke risk factors and a calculated historical CHADS-VASC score > 2 (Table 1). Over half of the patients with large vessel or small vessel/lacunar etiology were not on any antiplatelets and 53% of patients with known history of atrial fibrillation weren’t on anticoagulants. Forty-nine percent of patients had a mRS > 3 at discharge. Conclusion: Patients with several stroke risk factors are sub optimally managed by primary care providers. Primary prevention education for PCPs in management of higher stroke risk individuals and additional analysis of the CHADS-VASC tool for this setting is needed. If widely adapted, this tool may prevent strokes by providing adequate risk reduction in the primary care setting.

Download Full-text

Assessing gaps in cholesterol treatment guidelines for primary prevention of cardiovascular disease based on available randomised clinical trial evidence: The Rotterdam Study

European Journal of Preventive Cardiology ◽

10.1177/2047487317743352 ◽

2017 ◽

Vol 25 (4) ◽

pp. 420-431 ◽

Cited By ~ 6

Author(s):

Jelena Pavlović ◽

Philip Greenland ◽

Jaap W Deckers ◽

Maryam Kavousi ◽

Albert Hofman ◽

...

Keyword(s):

Cardiovascular Disease ◽

Clinical Trial ◽

Clinical Trials ◽

Primary Prevention ◽

Randomised Clinical Trial ◽

Lipid Lowering ◽

Randomised Clinical Trials ◽

Atherosclerotic Cardiovascular Disease ◽

Intermediate Risk ◽

Clinical Trial Evidence

Background The purpose of this study was to determine how American College of Cardiology/American Heart Association (ACC/AHA) 2013 and European Society of Cardiology 2016 guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) compare in reflecting the totality of accrued randomised clinical trial evidence for statin treatment at population level. Methods From 1997–2008, 7279 participants aged 45–75 years, free of atherosclerotic cardiovascular disease, from the population-based Rotterdam Study were included. For each participant, we compared eligibility for each one of 11 randomised clinical trials on statin use in primary prevention of CVD, with recommendations on lipid-lowering therapy from the ACC/AHA and European Society of Cardiology (ESC) guidelines. Atherosclerotic cardiovascular disease incidence and cardiovascular disease mortality rates were calculated. Results The proportion of participants eligible for each trial ranged from 0.4% for ALLHAT-LLT to 30.8% for MEGA. The likelihood of being recommended for lipid-lowering treatment was lowest for those eligible for low-to-intermediate risk RCTs (HOPE-3, MEGA, and JUPITER), and highest for high-risk individuals with diabetes (MRC/BHF HPS, CARDS, and ASPEN) or elderly PROSPER. Eligibility for an increasing number of randomised clinical trials correlated with a greater likelihood of being recommended lipid-lowering treatment by either guideline ( p < 0.001 for both guidelines). Conclusion Compared to RCTs done in high risk populations, randomised clinical trials targeting low-to-intermediate risk populations are less well-reflected in the ACC/AHA, and even less so in the ESC guideline recommendations. Importantly, the low-to-intermediate risk population targeted by HOPE-3, the most recent randomised clinical trial in this field, is not well-captured by the current European prevention guidelines and should be specifically considered in future iterations of the guidelines.

Download Full-text

Increased Cardiovascular Disease in Patients with Inflammatory Arthritis in Primary Care: A Cross-sectional Observation: Table 1.

The Journal of Rheumatology ◽

10.3899/jrheum.090010 ◽

2009 ◽

Vol 36 (9) ◽

pp. 1866-1868 ◽

Cited By ~ 12

Author(s):

MIKE J.L. PETERS ◽

MARK M.J. NIELEN ◽

HENNIE G. RATERMAN ◽

ROBERT A. VERHEIJ ◽

FRANCOIS G. SCHELLEVIS ◽

...

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Inflammatory Arthritis ◽

Care Setting ◽

Primary Care Setting ◽

Conditional Logistic Regression ◽

Regression Analyses ◽

Cross Sectional ◽

Cardiovascular Risk Management ◽

And Control

Objective.To compare the prevalence of cardiovascular disease (CVD) in patients with inflammatory arthritis and control subjects registered in primary care.Methods.Conditional logistic regression analyses were used to compare the CVD prevalence in patients and controls, aged 50–75 years.Results.Overall, the CVD prevalence was 66.1 per 1000 patients in inflammatory arthritis and 37.3 per 1000 patients in controls, resulting in an odds ratio of 1.83 (95% confidence interval 1.33–2.51).Conclusion.Inflammatory arthritis patients registered in primary care are associated with an increased cardiovascular burden, which emphasizes the need for cardiovascular risk management in the primary care setting.

Download Full-text