Key result
Only 0.3% and 2.4% of hypertensive patients had their cardiovascular risk assessed using national or alternative guideline-recommended tools, respectively, demonstrating poor compliance with risk stratification.
Why the study?
It was not well established whether physicians and cardiologists in Kenya comply with guideline-recommended CVD risk stratification before initiating primary CVD preventive interventions.
Observational (n=373)
No
There is poor compliance with guideline-recommended CVD risk assessment tools among physicians managing hypertensive patients in Kenya, representing a missed opportunity for appropriate risk-stratified primary prevention.
Supports routine atherosclerotic cardiovascular risk assessment in primary prevention; reinforces guideline-directed stratification amid rising modifiable risks in developing countries.
Introduction Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. It is projected that the prevalence of CVD will continue to rise in developing countries, largely driven by an increase in the prevalence of potentially modifiable risk factors. Atherosclerotic cardiovascular risk assessment among individuals with risk factors for CVD but without CVD is an inexpensive and viable strategy in CVD risk stratification and prevention. Despite the known benefits of CVD risk assessment, it is not well established whether physicians/ cardiologists in Kenya comply with the guideline-recommended practice of CVD risk stratification as a prerequisite for initiation of primary CVD preventive interventions. Aims and objectives This study was designed to audit the utilization of cardiovascular risk assessment tools in risk stratification of hypertensive individuals and physician provision of risk-based primary CVD prevention interventions. Results A five-year (2017-2022) retrospective study of patients’ medical records was conducted in December 2022 at the PrimeCare cardiology clinic in Nairobi Hospital, Kenya. Data were collected from 373 patients' medical records retrospectively. The data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). The mean age of the patients was 60 years with the majority being female (54%). The mean BMI was 30.3 kg/m2 while the mean systolic and diastolic pressure was 140mmHg and 80mmHg, respectively. Only 2.1% of participants were current smokers. The national or alternative guideline-recommended CVD risk assessment tool was used in 0.3% and 2.4%, respectively. The 10-year CVD risk score was documented in only 1.3%. The majority of the participants (93%) had low CVD risk. Half of the patients were taking statins for primary prevention while > 60% of them had been offered therapeutic lifestyle advice. Conclusion The study revealed poor compliance with guideline-recommended CVD risk assessment tools and documentation of the CVD risk level. However, there was above-average adherence to documentation of therapeutic lifestyle measures for primary CVD prevention.
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Ndede et al. (2023) conducted an observational in Hypertension (n=373). Guideline-recommended cardiovascular disease risk assessment vs. No documented risk assessment was evaluated on Use of the national guideline cardiovascular disease risk assessment tool. Only 0.3% and 2.4% of hypertensive patients had their cardiovascular risk assessed using national or alternative guideline-recommended tools, respectively, demonstrating poor compliance with risk stratification.
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