Cardiovascular screening in general practice in a low SES area

Q: What are the key findings of this study?

Pro-active GP-based cardiovascular screening in a low-SES practice achieved 62% attendance and identified a SCORE risk ≥5% in 40.3% of participants, of whom 60% were untreated.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease risk in a low socio-economic status (SES) population (n=521). Intervention: Pro-active GP-based cardiovascular risk screening supported by a regional GP laboratory in a low-SES area vs. Five other general practices using the same screening method (including one in a higher-SES municipality). Primary outcome: Proportion of analyzed participants with an elevated 10-year cardiovascular mortality risk (SCORE ≥5%) (MD 10.6%, 95% CI 2.06-19.20).

Q: What does this research mean for the field?

Proactive general practice-based cardiovascular screening in a low socioeconomic status population is feasible, achieves high attendance, and identifies elevated cardiovascular risk (SCORE ≥5%) in 40% of screened individuals, of whom 60% are previously untreated. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ans H Tiessen; Andries Jan Smit; Sebes Zevenhuizen; Edwin M. Spithoven; Klaas van der Meer

doi:10.1186/1471-2296-13-117

December 1, 2012BMC Family PracticeOpen Access

Cardiovascular screening in general practice in a low SES area

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Key result

Proactive GP screening in low-SES practices identifies high cardiovascular risk in ~40% of attendees.

MD +10.6%
95% CI 2.06-19.20
n=521

Why the study?

Lower socioeconomic status is related to elevated cardiovascular risk, and the feasibility, attendance rate, and yield of a proactive primary prevention cardiovascular screening approach in general practice supported by a regional laboratory needed to be investigated.

Key Points

To investigate the feasibility, attendance rate, and detection of elevated cardiovascular risk through proactive screening supported by a regional laboratory in a low socioeconomic general practice.
Invited men aged ≥50 years and women aged ≥55 years (N=521) in a low socioeconomic region for cardiovascular risk assessment conducted by laboratory staff at a general practice.
Evaluated cardiovascular profiles using the SCORE 10-year fatal cardiovascular risk tool along with family history, weight, and end-organ damage, guiding treatment advice by Dutch general practice standards.
Of 521 invited individuals, 354 (68%) showed interest, 33 did not attend, and 43 were excluded due to pre-existing diabetes or cardiovascular disease, leaving 278 risk profiles for final analysis.
Among the 278 analyzed participants, 60% had low risk (SCORE <5%) and 40% had elevated risk (SCORE ≥5%).
Among participants with a SCORE risk ≥5%, 60% were not currently receiving medication for hypertension or hypercholesterolemia, with response rates matching those of five comparator practices.

Study Design

Type

Cross-Sectional (n=521)

Multicenter

Yes

PICO

P

Population

521 adults (men ≥50 years, women ≥55 years) without registered diabetes or specialist cardiovascular follow-up invited for primary prevention screening in a low-SES Dutch general practice (278 risk profiles analyzed).

E

Exposure / Comparator

Pro-active GP-based cardiovascular risk screening supported by a regional GP laboratory in a low-SES area vs Five other general practices using the same screening method (including one in a higher-SES municipality)

O

Primary Outcome

Proportion of analyzed participants with an elevated 10-year cardiovascular mortality risk (SCORE ≥5%) — MD 10.6% (2.06-19.20)

Main Result

Mean Difference: 10.6 (95% CI 2.06–19.2)

Absolute Event Rate: 40.3% vs 29.6%

Limitations

Data primarily derived from a single specific general practice, which may limit external validity
Participating general practitioners may have been more motivated to improve cardiovascular screening and adjust practice organization than average practices, potentially overestimating the effect
Screening was not registered with a medical ethics committee as it was performed as an extension of usual care

Implication

Supports proactive screening feasibility in low-SES practices; leaves open effects on outcomes and cost-effectiveness.

Abstract

BACKGROUND: Lower social economic status (SES) is related to an elevated cardiovascular (CV) risk. A pro-active primary prevention CV screening approach in general practice (GP) might be effective in a region with a low mean SES. This approach, supported by a regional GP laboratory, was investigated on feasibility, attendance rate and proportion of persons identified with an elevated risk. METHODS: In a region with a low mean SES, men and women aged ≥ 50/55 years, respectively, were invited for cardiovascular risk profiling, based on SCORE 10-year risk of fatal cardiovascular disease and additional risk factors (family history, weight and end organ damage). Screening was performed by laboratory personnel, at the GP practice. Treatment advice was based on Dutch GP guidelines for cardiovascular risk management. Response rates were compared to those in five other practices, using the same screening method. RESULTS: 521 persons received invitations, 354 (68%) were interested, 33 did not attend and 43 were not further analysed because of already known diabetes/cardiovascular disease. Eventually 278 risk profiles were analysed, of which 60% had a low cardiovascular risk (SCORE-risk <5%). From the 40% participants with a SCORE-risk ≥ 5%, 60% did not receive medication yet for hypertension/hypercholesterolemia. In the other five GPs response rates were comparable to the currently described GP. CONCLUSION: Screening in GP in a low SES area, performed by a laboratory service, was feasible, resulted in high attendance, and identification and treatment advice of many new persons at risk for cardiovascular disease.

Discussion

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Cite This Study

Tiessen et al. (2012) conducted a cross-sectional in Cardiovascular disease risk in a low socio-economic status (SES) population (n=521). Pro-active GP-based cardiovascular risk screening supported by a regional GP laboratory in a low-SES area vs. Five other general practices using the same screening method (including one in a higher-SES municipality) was evaluated on Proportion of analyzed participants with an elevated 10-year cardiovascular mortality risk (SCORE ≥5%) (MD 10.6%, 95% CI 2.06-19.20). Pro-active GP-based cardiovascular screening in a low-SES practice achieved 62% attendance and identified a SCORE risk ≥5% in 40.3% of participants, of whom 60% were untreated.

synapsesocial.com/papers/6ae7833218c06a03bcc113fe https://doi.org/10.1186/1471-2296-13-117

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Cardiovascular screening in general practice in a low SES area

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiovascular screening in general practice in a low SES area

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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