Real-world cardiovascular risk assessment, and blood pressure and LDL-cholesterol control, by different medical specialties, during and post COVID-19 pandemia (SNAPSHOT studies Romania)

Background Real-world data on cardiovascular risk (CV) assessment by various medical specialties, as well as the perceived and real control of hypertension and dyslipidemia, are limited. Purpose To compare the perceived CV risk, as well as the perceived rate of blood pressure (BP) and low-density lipoprotein-cholesterol (LDL-C) control, assessed by different medical specialties, with the ESC guideline recommendations. Methods Two observational, cross-sectional, epidemiological studies, with similar design, were conducted in Romania during pandemic (SNAPSHOT-1, June 2021) and post-pandemic (SNAPSHOT-2, June 2022), including consecutive outpatients, diagnosed with both hypertension and dyslipidaemia. They were assessed by different medical specialties: cardiologists, internal medicine, diabetologists, and general practitioners (GPs). CV risk, as well as BP and LDL-C control, for each patient, were evaluated by physician assessment and according to the ESC guidelines recommendations. Results 5004 patients with hypertension and dyslipidaemia were included: 2469 in SNAPSHOT-1 (60 GPs, 43 cardiologists, and 27 diabetologists enrolled 1173, 776, and 520 patients, respectively), and 2535 in SNAPSHOT-2 (59 GPs, 38 cardiologists, 26 diabetologists, and 2 internal medicine specialists enrolled 1213, 765, 522, and 35 patients, respectively). Investigators perception of BP and LDL-C control, compared to ESC guideline recommendations, were inconsistent, with BP and LDL-C control rates being hugely overestimated across all medical specialties, mostly among GPs; overall BP and LDL-C control were very low, regardless of medical specialty (Table 1). In SNAPSHOT-1, GPs estimated CV risk as "high" or "very high" for 33.2% and 23.4% of patients, respectively, whereas CV risk based on guideline recommendations (SCORE) was 10.1% and 82.9% respectively; cardiologists estimated CV risk as "high" or "very high" for 29.9% and 41.9% of patients, respectively, whereas CV risk based on guideline recommendations (SCORE) was 12.8 % and 81% respectively; diabetologists estimated CV risk as "high" or "very high" for 43.5% and 52.8% of patients, respectively, whereas CV risk based on guideline recommendations (SCORE) was 17.7% and 80.5%, respectively. Thus, 30% of GPs, 45% of cardiologists, and 61% of diabetologists accurately estimated CV risk; conversely, 67% of GPs, 49% of cardiologists, and 33% of diabetologists underestimated CV risk. These findings were similar to SNAPSHOT-2 (Figure 1). Conclusions SNAPSHOT studies showed that assessment of CV risk was substantially underestimated by various medical specialties managing patients with coexisting hypertension and dyslipidemia, mostly by GPs. Additionally, physicians, mostly GPs, largely overestimated BP and LDL-C control, compared to the real control rates, as per guideline recommendations. Results were consistent when assessing a similar population during COVID-19 pandemic and in the post-pandemic period.Table 1.BP and LDL-C control. Figure 1.Estimation of CV Risk.