Prevention continuum: an assessment of cardiovascular disease prevention based on the data from a survey of doctors

Aim. To assess the awareness and engagement of health professionals in Russia in the main aspects of cardiovascular disease prevention.Material and methods. In order to assess engagement and awareness, an online survey of Russian primary health care providers was conducted in March 2021. The survey was conducted using original questionnaire, which includes the main questions aimed at early identification of patients with modifiable cardiovascular risk factors.Results. In case of newly diagnosed hypercholesterolemia and elevated blood pressure during screening, 91,8% (n=458) of the surveyed medical specialists record the results and immediately consult the patient on these issues. Similar responses was obtained by 93% (n=464) of doctors for patients with previously prescribed antihypertensive and/or lipid-lowering therapy. In addition, 46,5% (n=232) responded that during screening, 10-30% of patients had newly diagnosed hypertension and/or total cholesterol >5 mmol/L. A total of 28,9% (n=144) of respondents noted that 30-50% of patients with newly diagnosed hypertension and/or total cholesterol >5 mmol/L are detected at screening. It is noteworthy that 41,9% (n=209) of physicians devote 1 to 5 minutes to a patient, describing the changes in lifestyle, diet and physical activity. For 35,1% (n=175) of the respondents, this takes from 5 to 10 minutes, 22% (n=110) — >10 minutes, while ~5 respondents refer patients to another specialist for this purpose.Conclusion. The survey showed a high awareness of medical specialists in the need to monitor and modify risk factors. However, ~40% of surveyed doctors do not devote enough time to explaining issues of modifying lifestyle, diet and physical activity.

Health Behavior Change Programs in Primary Care and Community Practices for Cardiovascular Disease Prevention and Risk Factor Management Among Midlife and Older Adults: A Scientific Statement From the American Heart Association

Cardiovascular disease predominates as the leading health burden among middle-aged and older American adults, but progress in improving cardiovascular health remains slow. Comprehensive, evidenced-based behavioral counseling interventions in primary care are a recommended first-line approach for promoting healthy behaviors and preventing poor cardiovascular disease outcomes in adults with cardiovascular risk factors. Assisting patients to adopt and achieve their health promotion goals and arranging follow-up support are critical tenets of the 5A Model for behavior counseling in primary care. These 2 steps in behavior counseling are considered essential to effectively promote meaningful and lasting behavior change for primary cardiovascular disease prevention. However, adoption and implementation of behavioral counseling interventions in clinical settings can be challenging. The purpose of this scientific statement from the American Heart Association is to guide primary health care professional efforts to offer or refer patients for behavioral counseling, beyond what can be done during brief and infrequent office visits. This scientific statement presents evidence of effective behavioral intervention programs that are feasible for adoption in primary care settings for cardiovascular disease prevention and risk management in middle-aged and older adults. Furthermore, examples are provided of resources available to facilitate the widespread adoption and implementation of behavioral intervention programs in primary care or community-based settings and practical approaches to appropriately engage and refer patients to these programs. In addition, current national models that influence translation of evidence-based behavioral counseling in primary care and community settings are described. Finally, this scientific statement highlights opportunities to enhance the delivery of equitable and preventive care that prioritizes effective behavioral counseling of patients with varying levels of cardiovascular disease risk.

Immigration Status and Sex Differences in Primary Cardiovascular Disease Prevention: A Retrospective Study of 5 Million Adults

Background We evaluated whether immigration status modified the association between sex and the quality of primary cardiovascular disease prevention in Ontario, Canada. Methods and Results We used a population‐based administrative database‐derived cohort of community‐dwelling adults (aged ≥40 years) without prior cardiovascular disease residing in Ontario on January 1, 2011. In the preceding 3 years, we evaluated screening for hyperlipidemia and diabetes in those not previously diagnosed; diabetes control (HbA 1c <7%); and medication use to control hypertension, hyperlipidemia, or diabetes in those with previous diagnosis. We calculated the absolute prevalence difference (APD) between women and men for each metric stratified by immigration status and then determined the difference‐in‐differences for immigrants compared with long‐term residents. Our sample included 5.3 million adults (19% immigrants), with receipt of each metric ranging from 55% to 90%. Among immigrants, women were more likely than men to be screened for hyperlipidemia (APD, 10.8%; 95% CI, 10.5–11.2) and diabetes (APD, 11.5%; 95% CI, 11.1–11.8) and to be treated with medications for hypertension (APD, 3.5%; 95% CI, 2.4–4.5), diabetes (APD, 2.1%; 95% CI, 0.7–3.6) and hyperlipidemia (APD, 1.8%; 95% CI, 0.5–3.1). Among long‐term residents, findings were similar except poorer medication use for diabetes (APD, −2.8%; 95% CI, −3.4 to −2.2) and hyperlipidemia (APD, −3.5%; 95% CI, −4.0 to −3.0]) in women compared with men. Conclusions The overall quality of primary preventive care can be improved for all adults, and future research should evaluate the impact of observed equal or better care in women than men, irrespective of immigration status, on cardiovascular disease incidence.