Cardiovascular Disease Risk Factor Recording Research Articles

SURF-COPD: the recording of cardiovascular risk in patients with chronic lung disease.

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic obstructive pulmonary disease (COPD) and such patients tend to carry a heavy burden of risk factors for CVD. There is little information on the documentation and management of CVD risk factors in COPD patients. To audit the recording and management of CVD risk factors in 200 COPD patients attending the respiratory out-patient clinics at two University teaching hospitals. Retrospective analysis of hospital records. While there was reasonable recording of a history of CVD risk factors such as hypertension and hyperlipidaemia, the actual recording of risk factor levels was poor-blood pressure and heart rate were recorded in less than half of subjects; lipids, waist circumference, HbA1c and height were essentially not recorded at all. Best practice guidelines and standard operating procedures for CVD risk factor recording and control require to be developed if the major cause of death in COPD subjects, CVD, is to be addressed. An outline for a standard operating procedure is presented in the Appendix. Serial audits will be required to assess the efficacy of such measures.

Cardiovascular disease screening in general practice: General practitioner recording of common risk factors.

The assessment and screening of individual risk factors for cardiovascular disease (CVD) is a critical component of CVD prevention strategies in general practice (GP). This study sought to examine current CVD risk factor recording as recommended by Australian guidelines for the management of absolute cardiovascular disease risk. A retrospective analysis of routine GP data from 149,306 GP patients aged 45years and above in eastern Melbourne was conducted. Data were collected from GP clinics located throughout inner east Melbourne from July 2011 to September 2014 through the Melbourne East Monash General Practice Database. Recording of primary risk factors necessary for CVD screening as recommended by the national guidelines was assessed, and logistic regression with generalised estimating equations was used to estimate associations between patient characteristics and risk factor recording. 137,976 (92.4%) patients were found to have had at least one risk factor recorded, 62,214 (41.7%) had the Framingham risk factors recorded (lipids, blood pressure, smoking status), while only 1957 (1.3%) had all risk factors recorded. Females (Odds Ratio [OR]: 0.72, 95% Confidence Interval [CI]: 0.65, 0.81), and those identified with diabetes (OR: 12.26, 95% CI: 9.58, 15.68) were less and more likely to have documented risk factors, respectively. Given the role of GPs in the prevention and management of CVD, it is important to improve the identification of high risk patients through screening and recording of CVD risk factors. Strategies are therefore needed to encourage ongoing CVD risk factor recording to support preventive care by GPs.

Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study

ObjectivesInvestigate the association between socioeconomic deprivation and completeness of cardiovascular disease (CVD) risk factor recording in primary care, uptake of screening in people with incomplete risk factor recording and with...

Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study.

IntroductionWe previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and a concurrent low CVD risk according to the SCORE.MethodsA cohort of 144 women with an evaluated low risk of CVD (SCORE value of zero) was assembled amongst 550 consecutive patients with RA that underwent CVD risk factor recording and carotid artery ultrasound. Participants had no established CVD, moderate or severe chronic kidney disease, or diabetes. We assessed carotid plaque(s) presence and its associated patient characteristics.ResultsCarotid artery plaque was present in 35 (24.3%) of women with RA. Age, the number of synthetic disease-modifying agents (DMARDs) and total cholesterol concentrations were independently associated with plaque in multivariable stepwise backward regression analysis (odds ratio (95% confidence interval) = 1.15 (1.07 to 1.24), P <0.0001, 1.51 (1.05 to 2.17), P = 0.03 and 1.66 (1.00 to 2.73) P = 0.04), respectively). The area under the curve (AUC) of the receiver operating curve (ROC) for the association with plaque was 0.807 (P <0.0001), 0.679 (P = 0.001) and 0.599 (P = 0.08) for age, total cholesterol concentrations and number of synthetic DMARDs used, respectively. The optimal cutoff value in predicting plaque presence for age was 49.5 years with a sensitivity and specificity of 74% and 75%, respectively, and for total cholesterol concentration, it was 5.4 mmol/l with a sensitivity and specificity of 63% and 70%, respectively. The plaque prevalence was 37.5% in patients (n = 80; 55.6%) with age >49.5 years or/and total cholesterol concentration of >5.4 mmol/l, respectively, compared to only 7.8% in those (n = 64; 44.4%) with age ≤49.5 years or/and total cholesterol concentration of ≤5.4 mmol/l, respectively.ConclusionsApproximately one-third of women with RA who experience a low SCORE value and are aged >49.5 years or/and have a total cholesterol concentration of >5.4 mmol/l, experience high-risk atherosclerosis, which requires intensive CVD risk management.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0576-7) contains supplementary material, which is available to authorized users.

Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice

As physicians we like to have evidence for making decisions about interventions to improve health. The evidence vacuum in the field of cardiovascular disease (CVD) prevention and clinical outcome in...

Assessment of cardiovascular risk factors prior to NHS Health Checks in an urban setting: cross-sectional study.

ObjectivesTo assess the completeness of cardiovascular disease (CVD) risk factor recording and levels of risk factors in patients eligible for the NHS Health Check.DesignCross-sectional study.SettingTwenty-eight general practices located in Hammersmith and Fulham, London, UK.Participants42,306 patients aged 40 to 74 years without existing cardiovascular disease or diabetes.Main Outcome MeasuresMeasurement and level of CVD risk factors: blood pressure, cholesterol, body mass index (BMI), blood glucose and smoking status.ResultsThere was a high recording of smoking status (86.1%) and blood pressure (82.5%); whilst BMI, cholesterol and glucose recording was lower. There was large variation in BMI, cholesterol, glucose recording between practices (29.7–91.5% for BMI). Women had significantly better risk factor recording than men (AOR = 1.70 [1.61–1.80] for blood pressure). All risk factors were better recorded in the least deprived patient group (AOR = 0.79 [0.73–0.85] for blood pressure) and patients with diagnosed hypertension (AOR = 7.24 [6.67–7.86] for cholesterol). Risk factor recording varied considerably between practices but was more strongly associated with patient than practice level characteristics. Age-adjusted levels of cholesterol and BMI were not significantly different between men and women. More men had raised blood glucose, blood pressure and BMI than women (29.7% [29.1–30.4] compared to 19.8% [19.3–20.3] for blood pressure).ConclusionsBefore the NHS Health Check, CVD risk factor recording varied considerably by practice and patient characteristics. We identified significant elevated levels of raised CVD risk factors in the population eligible for a Health Check, which will require considerable work to manage.

Implementation of the NHS Health Checks programme: baseline assessment of risk factor recording in an urban culturally diverse setting

National Health Service (NHS) Health Checks, a population-wide prevention programme introduced during 2009, aims to measure and manage cardiovascular disease (CVD) risk factors among all persons aged 40-74 years in England. The potential workload implications of the programme for general practice are considerable, particularly in deprived culturally diverse settings. To examine the baseline levels of CVD risk factor recording in general practices located in Ealing, North West London. Cross-sectional study using data extracted from electronic medical records in 14 general practices between December 2008 and January 2009. The completeness of blood pressure, smoking, body mass index (BMI) and cholesterol recording was examined by practice and patient characteristics. Recording of blood pressure [85.6% (practice interquartile range = 10.1)] and smoking status [95.8% (2.6)] was very high in practices. Recording of BMI [72.8% (23.4)] and cholesterol [55.6% (25.3)] was considerably lower. There were large differences in recording between practices (range for cholesterol: 33.6-78.0%), though these were largely explained by patient characteristics. In regression analysis, hypertensive patients [adjusted odds ratio (AOR) = 36.3, 95% confidence interval (CI) 21.0-62.9], women [AOR = 2.88 (95% CI 2.64-3.15)] and older patients [AOR = 2.75 (95% CI 2.28-3.32) for 65-74 against 35-44 years of age] had better recording of blood pressure as well as BMI and cholesterol. Recording of blood pressure [AOR = 1.38 (95% CI 1.09-1.75)] and cholesterol [AOR = 1.47 (95% CI 1.30-1.66)] was significantly higher among South Asian patients. The workload implications of the NHS Health Checks programme for general practices in England are substantial. There are considerable variations in risk factor recording between practices and between age, gender and ethnic groups.

Inequity in Recording of Risk in a Local Population-Based Screening Programme for Cardiovascular Disease

Background Screening for cardiovascular disease is an important primary preventive measure, yet research has documented that not all population groups receive the same quality of preventive healthcare. Design Longitudinal analysis of cardiovascular disease risk factor recording. Methods Data were made available from a local population-based screening programme for cardiovascular disease (1989-1999), whereby residents aged 35-60 years were invited for screening every 5 years (n = 84 646). Data were recorded for major risk factors including blood pressure, cholesterol, body mass index, smoking status, and alcohol consumption. Completeness of risk factor recording was compared between groups in the screened population defined by gender, ethnicity (Caucasian/South Asian) and employment status (employed/unemployed). Results Recording of risk in the screened population was significantly less complete for women and South Asian participants over the duration of the screening programme, compared with men and Caucasian participants respectively. Conversely, recording of risk was significantly more complete for the unemployed compared with the employed participants. Conclusions These findings present evidence of a less systematic screening procedure for women and South Asians, whilst it seems that men, Caucasian participants and the unemployed were appropriately screened. Inequalities at the primary preventive level will likely influence outcome, because equitable identification of risk is important for the provision of successful treatment measures, and to reduce inequalities in morbidity and mortality due to cardiovascular disease.