scholarly journals Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoltán Jancsó ◽  
Imre Rurik ◽  
László Kolozsvári ◽  
Lajos Mester ◽  
Anna Nánási ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Diabetes Care ◽  
Structural Changes ◽  
Ldl Cholesterol ◽  
Diabetic Patients ◽  
High Cardiovascular Risk ◽  
Target Values ◽  
Euroaspire Iii

Abstract Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

Abstract 003: Personalizing the Intensity of Blood Pressure Control: Modeling the Heterogeneity of Risks and Benefits From the SPRINT Trial

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Krishna K Patel ◽  
Suzanne V Arnold ◽  
Paul S Chan ◽  
Yuanyuan Tang ◽  
Yashashwi Pokharel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Prediction Models ◽  
Risk Model ◽  
Treatment Strategies ◽  
Intensive Treatment ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
High Cardiovascular Risk ◽  
Serious Adverse Events

Introduction: In SPRINT (Systolic blood PRessure INtervention Trial), non-diabetic patients with hypertension at high cardiovascular risk treated with intensive blood pressure (BP) control (<120mmHg) had fewer major adverse cardiovascular events (MACE) and all-cause deaths but higher rates of serious adverse events (SAE) compared with patients treated with standard BP control (<140mmHg). However, the degree of benefit or harm for an individual patient could vary due to heterogeneity in treatment effect. Methods: Using patient-level data from SPRINT, we developed predictive models for benefit (freedom from death or MACE) and harm (increased SAE) to allow for individualized BP treatment goals based on projected risk-benefit for each patient. Interactions between candidate variable and treatment were evaluated in the models to identify differential treatment effects. We performed 10 fold cross-validation for both the models. Results: Among 9361 patients, 8606 (92%) patients had no MACE or death event (benefit) and 3529 (38%) patients had a SAE (harm) over a median follow-up of 3.3 years. The benefit model showed good discrimination (c-index= 0.72; cross-validated c-index= 0.72) with treatment interactions of age, sex, and baseline systolic BP (Figure A), with more benefit of intensive BP treatment in patients who are older, male, and have lower baseline SBP. The SAE risk model showed moderate discrimination (c-index=0.66; cross-validated c-index= 0.65) with a treatment interaction of baseline renal function (Figure B), indicating less harm of intensive treatment in patients with a higher baseline creatinine. The mean predicted absolute benefit of intensive BP treatment was of 2.2% ± 2.5% compared with standard treatment, but ranged from 10.7% lower benefit to 17% greater benefit in individual patients. Similarly, mean predicted absolute harm with intensive treatment was 1.0% ± 1.9%, but ranged from 15.9% lesser harm to 4.9% more harm. Conclusion: Among non-diabetic patients with hypertension at high cardiovascular risk, we developed prediction models using basic clinical data that can identify patients with higher likelihood of benefit vs. harm with BP treatment strategies. These models could be used to tailor the treatment approach based on the projected risk and benefit for each unique patient.

scholarly journals Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

2020 ◽  
pp. 204748732090869 ◽  
Author(s):  
Kornelia Kotseva ◽  
Guy De Backer ◽  
Dirk De Bacquer ◽  
Lars Rydén ◽  
Arno Hoes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
European Society ◽  
Research Programme ◽  
European Countries ◽  
High Cardiovascular Risk ◽  
European Society Of Cardiology

Background European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication. Results A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.

scholarly journals Hypertension Management in the High Cardiovascular Risk Population

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ilir Maraj ◽  
John N. Makaryus ◽  
Anthony Ashkar ◽  
Samy I. McFarlane ◽  
Amgad N. Makaryus
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Diabetic Patients ◽  
Hypertension Management ◽  
High Cardiovascular Risk ◽  
Risk Population ◽  
Real Challenge ◽  
Prevention Of Cardiovascular Disease

The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascular risk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more and more people survive acute myocardial infarction. We will review hypertension management in the high cardiovascular risk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients.

scholarly journals Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care

2016 ◽  
Vol 11 (2) ◽  
pp. 49-56 ◽  
Author(s):  
Mohamed Alami ◽  
Mustapha El Hattaoui ◽  
Mehdi Seqat ◽  
Jamaa Sadik ◽  
Aicha Aouad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Uncontrolled Hypertension ◽  
Newly Diagnosed ◽  
High Cardiovascular Risk ◽  
Prospective Longitudinal Study ◽  
Hypertensive Patients ◽  
Prospective Longitudinal

Background: Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. Methods: This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. Results: A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40–60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. Conclusions: More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

scholarly journals Computerized clinical decision support system for diabetes in primary care does not improve quality of care: a cluster-randomized controlled trial

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Annemie Heselmans ◽  
Nicolas Delvaux ◽  
Annouschka Laenen ◽  
Stijn Van de Velde ◽  
Dirk Ramaekers ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Diabetes Care ◽  
Ldl Cholesterol ◽  
Clinical Decision ◽  
Secondary Outcomes ◽  
Cluster Randomized ◽  
To Receive

Abstract Background The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. There is no clear evidence of more complex CCDS systems to manage chronic diseases in primary care practices (PCPs). The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care. Methods A cluster-randomized trial with before-and-after measurements was performed in Belgian PCPs over 1 year, from May 2017 to May 2018. We randomly assigned 51 practices to either the intervention group (IG), to receive the EBMeDS system, or to the control group (CG), to receive usual care. Primary and secondary outcomes were the 1-year pre- to post-implementation change in HbA1c, LDL cholesterol, and systolic and diastolic blood pressure. Composite patient and process scores were calculated. A process evaluation was added to the analysis. Results were analyzed at 6 and 12 months. Linear mixed models and logistic regression models based on generalized estimating equations were used where appropriate. Results Of the 51 PCPs that were enrolled and randomly assigned (26 PCPs in the CG and 25 in the IG), 29 practices (3815 patients) were analyzed in the study: 2464 patients in the CG and 1351 patients in the IG. No change differences existed between groups in primary or secondary outcomes. Change difference between CG and IG after 1-year follow-up was − 0.09 (95% CI − 0.18; 0.01, p-value = 0.06) for HbA1c; 1.76 (95% CI − 0.46; 3.98, p-value = 0.12) for LDL cholesterol; and 0.13 (95% CI − 0.91; 1.16, p-value = 0.81) and 0.12 (95% CI − 1.25;1.49, p-value = 0.86) for systolic and diastolic blood pressure respectively. The odds ratio of the IG versus the CG for the probability of no worsening and improvement was 1.09 (95% CI 0.73; 1.63, p-value = 0.67) for the process composite score and 0.74 (95% CI 0.49; 1.12, p-value = 0.16) for the composite patient score. All but one physician was satisfied with the EBMeDS system. Conclusions The CCDS system EBMeDS did not improve diabetes care in Belgian primary care. The lack of improvement was mainly caused by imperfections in the organizational context of Belgian primary care for chronic disease management and shortcomings in the system requirements for the correct use of the EBMeDS system (e.g., complete structured records). These shortcomings probably caused low-use rates of the system. Trial registration ClinicalTrials.gov, NCT01830569, Registered 12 April 2013.

scholarly journals Alirocumab effectiveness and rapidity in achieving and maintaining target LDL, HDL cholesterol and triglyceride values in patients at very high cardiovascular risk

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Cavarra ◽  
E Salerno ◽  
G Chiaranda"
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Case Studies ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
High Cardiovascular Risk ◽  
Target Value ◽  
Target Values ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Still too few patients after an acute cardiocerebrovascular event reach C-LDL values recommended by guidelines even in therapy with statins and ezetimibe, thus maintaining a high risk of new cardiovascular episodes. Purpose To evaluate, in a long follow-up, the effectiveness and the rapidity of alirocumab in the attainment and maintenance of LDL-cholesterol target values in patients at very high risk and intolerant to statins. Methods Our case studies consist of 72 patients, 80% males (58) and 20% females (14), with an average age of 61.9. 90.2% of patients were hypertensive. 5.5% had chronic kidney disease (CKD stage III). 65.2% had an ACS and the 34.7% had CeVD. 84.7% of the patients were in therapy only with ezetimibe while 15.3% in association with PUFA N-3. The average value of C-LDL was 169.2 mg/dl. The follow up was 24 months with clinical checks and C-LDL at 3,6,12 and 24 months. The dosage of alirocumab was both 75 and 150 mg Results At 3 months the reduction of C-LDL was 52.24%; at 6 months of 51.18%; at 12 months of 51.36% and at 24 months of 52.47%. The 37 patients who had started with 150 mg, had a very high average C-LDL base, 183.0 mg/dl, and showed a reduction of C-LDL to 3 months of 59.04%, to 6 months of 58.45%, to 12 months of 65.05%, to 24 months of 55.76%. The target value of C-LDL recommended by the ESC guidelines was reached for 42.10% at 3 months; for 52.63% at 6 months; for 63.15% at 12 months and for 73.68% at 24 months. 5.5% of patients with a CKD showed a 73.68% reduction in C-LDL values to 3 months, 65.22% to 6 months, 57.49% to 12 months and 53.95% to 24 months. The follow-up to the Tg study showed a reduction of 3.55% to 3 months, an increase of 8.75% to 6 months, a reduction of 1.65% to 12 months and 7.95% to 24 months. C-HDL values showed an increase of 4.55% at 3 months, 3.69% at 6 months, 10.97% at 12 months and 7.82% at 24 months.  Conclusions Our case studies have confirmed the effectiveness of alirocumab in reducing C-LDL values in patients at very high cardiovascular risk and the rapidity in reaching the target value set by guidelines for the management of cardiovascular risk. Our study also confirmed the its effectiveness in increasing the values of C-HDL while it was not possible to confirm the reduction of Tg values. % Alirocumab Efficacy C-LDL TGs C-HDL 3 MONTHS -52,24% -3,55% +4,55% 6 MONTHS -51,18% +8,75% +3,69% 12 MONTHS -51,36% -1,65% +10,97% 24 MONTHS -52,47% -7,95% +7,82% C-LDL: LDL-CHOLESTEROL TGs TRIGLYCERIDES C-HDL: HDL-CHOLESTEROL Abstract Figure. % Alirocumab Efficacy

Prevalence of Inter Arm Blood Pressure Difference among Type 2 Diabetics in Primary Care

2018 ◽  
Vol 3 (09) ◽  
Author(s):  
Dr. Amal Al Balushi ◽  
Dr Firdous Jahan ◽  
Dr. Maiya Al Jahdhami ◽  
Dr. Kamlesh Bhargava
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Pressure Difference ◽  
Diabetic Patients ◽  
Duration Of Diabetes ◽  
Blood Pressure Difference ◽  
Type 2 Diabetics ◽  
Patients With Diabetes

Hypertension in patients with diabetes is a common problem; it increases the risk of cardiovascular, renal and ophthalmologic complications. Appropriate measurement of blood pressure is important, as the readings are the target of all pharmacological and non-pharmacological treatment. The aim of the present study was to observe the prev-alence of significant difference in blood pressure in the arms in type 2 Diabetics and to establish if there is association between inter-arm blood pressure difference (IAD) and cardiovascular risk. A cross sectional study conducted in 5 primary care health centers. BP measurements were done by automatic Omron 7 machine; the measure-ments were done two times with interchanging the instruments between two arms. Da-ta collection included demographic data (including, age, sex, body mass index (BMI), waist circumferences, duration of Diabetes, history of HTN, and smoking status).The data collection form also included entry of last biochemical investigations done in-cluding total cholesterol, LDL, HDL, triglyceride, glycosylated hemoglobin (HbA1c) and Cardiovascular risk (CV risk ) calculated by UKPDS engine version 2.0. Data was analyzed with SPSS (version 19). A total of 155 patients were studied. Mean age of patients was 55yrs. 22 participants (14.2, 95% CI=9.1-20.7) had systolic IAD >10 mmHg, 51 (33%, 95% CI=25.6-40.9) had a diastolic IAD >5 mmHg and 9 (5.8 %, 95% CI=2.7-10.7) had a diastolic difference >10 mmHg. In addition, the results showed statistically significant correlation between systolic interarm BP difference and duration of diabetes (P=0.025).There is significant diastolic interarm blood pres-sure difference in diabetic patients. Hence it is important to measure the blood pres-sure in both arms for patients with diabetes to treat hypertension in diabetics appropri-ately.

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