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Effectiveness of a hospital-based vascular screening programme (SMART) for risk factor management in patients with
B G Brouwer1, F L J Visseren, A Algra
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Systematic vascular risk factor screening modestly improved outcomes for patients with established vascular disease or type 2 diabetes. However, many patients still did not meet treatment goals, indicating screening alone is insufficient for optimal risk management.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Effective modification of vascular risk factors is crucial for reducing mortality and morbidity in patients with symptomatic atherosclerosis.
- Achieving and maintaining optimal risk factor levels remains a significant clinical challenge.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary, hospital-based vascular screening program in managing risk factors.
- To compare risk factor status in patients with established vascular disease or type 2 diabetes who participated in the Second Manifestations of ARTerial disease (SMART) program versus those who did not.
Main Methods:
- The Risk management in Utrecht and Leiden Evaluation (RULE) study enrolled patients with established vascular disease or type 2 diabetes.
- Risk factor status (blood pressure, LDL cholesterol, glucose, creatinine, weight, waist circumference, smoking) was assessed 12-18 months post-referral.
- A comparison was made between patients attending a screening program (UMC Utrecht) and those receiving usual care (Leiden UMC).
Main Results:
- Patients in the screening program showed slightly lower systolic blood pressure and LDL cholesterol levels compared to the usual care group.
- These differences were statistically significant (systolic BP: 2.5 mmHg, LDL: 0.3 mmol/L).
- The study included 604 patients in the screening group and 566 in the usual care group, with 70% being male and a mean age of 61 years.
Conclusions:
- Systematic screening and tailored treatment advice led to modest improvements in risk factor reduction for high-risk patients.
- A significant proportion of patients did not achieve guideline-recommended treatment goals.
- Screening for vascular risk factors alone is insufficient for comprehensive risk management in patients with established vascular disease or type 2 diabetes.
Aims:
Modification of vascular risk factors is effective in reducing mortality and morbidity in patients with symptomatic atherosclerosis; however, it is difficult to achieve and maintain. The aim of the Risk management in Utrecht and Leiden Evaluation (RULE) study was to assess risk factor status after referral in patients with established vascular disease or type 2 diabetes who took part in the multidisciplinary hospital-based vascular screening programme, Second Manifestations of ARTerial disease, compared with a group who did not participate in such a programme.
Methods And Results:
Patients with type 2 diabetes, coronary artery disease, cerebrovascular disease or peripheral arterial disease referred by general practitioners to the medical specialist at the University Medical Center (UMC) Utrecht (a setting with a vascular screening programme of systematic screening of risk factors followed by treatment advice) and the Leiden UMC (a setting without such a screening programme), were enrolled in the study. Blood pressure, levels of lipids, glucose and creatinine, weight, waist circumference and smoking status were measured in patients 12-18 months after referral to the two hospitals. A total of 604 patients were treated in the setting with a vascular screening programme and 566 in the setting without such a programme; 70% of all patients were male, with a mean age of 61 +/- 10 years. Amongst screened patients, systolic blood pressure [2.5 mmHg, 95% confidence interval (CI) 0.3-4.6] and the level of LDL cholesterol (0.3 mmol L(-1), 95% CI 0.2-0.4) were lower compared with the group that received usual care, after a median of 16 months from referral.
Conclusion:
Systematic screening of risk factors, followed by evidence-based, tailored treatment advice contributed to slightly better risk factor reduction in patients with established vascular disease or type 2 diabetes. However, a large proportion of patients did not reach the treatment goals according to (inter)national guidelines. Systematic screening of vascular risk factors alone is not enough for adequate risk factor management in high-risk patients.
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