Impact of a multimorbidity-focused national general practice chronic disease programme on cardiovascular risks factors

Abstract

Abstract Introduction Multimorbidity occurs in adults of all ages, but the number and complexity of comorbid conditions commonly increases with advancing age. Therefore cardiovascular disease (CVD) in older adults typically occurs in a context of multimorbidity. Current clinical practice and research mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions. A national chronic disease programme focused on multimorbid patients was developed, with funding based on process rather than outcome measures. The conditions included were chronic coronary syndromes, heart failure, atrial fibrillation, transient ischaemic attacks, stroke, diabetes, COPD and asthma. This report focuses on the initial results of this programme. Methods The programme commenced in March 2020 and analysis occurred based on patients returned by January 2022. The programme involved general practice teams providing a maximum of two visits to eligible patients every 12 months. The visit structure was supported by adaptation of the electronic health record returns depending on the conditions involved. The programme was introduced on a phased basis so that only those over 65 years were included in this analysis. Among all programme participants who had three visits, data on risk factors such as smoking, alcohol, physical activity, weight, blood pressure (BP), and lipid control were collected. HbA1c was also collected in those with diabetes. Results 186,210 people were enrolled in the programme by January 2022. 13% of patients who were current smokers ceased smoking between first and third programme visits. In those who had inadequate physical activity levels at their first visit, almost 30% had achieved adequate physical activity levels by their third visit. Of those who had increased, high risk or harmful alcohol consumption patterns at visit one, 8.3% had become non-drinkers and 58.7% had normal drinking patterns by visit three. There was a population drop of a mean of 1mmHg in BP during the programme. Of those with elevated BP at visit one, 43.4% had a BP <140/90 mmHg at visit three. The mean LDL cholesterol of the cohort was 2.2 mmol/L. In those with diabetes and ischaemic heart disease, 49% had an LDL cholesterol <1.8mmol/l. By visit three, 23% of those with an LDL cholesterol initially above target subsequently had an LDL level <1.8 mmol/L. The mean HbA1c in people with diabetes was 53.5 mmol/mol. 40% of those with a HbA1c >64mmol/mol reduced this level between first and third visits. 81% of patients had received influenza vaccination. 75% of patients had received a pneumococcal vaccine. Conclusion Despite the COVID 19 pandemic a general practice based multimorbidity focused chronic disease management programme had significant impact on cardiovascular risk factors.