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Modelling different strategies to prevent coronary heart disease in primary care
C Silagy1, D Mant, L Carpenter
1Department of General Practice, Flinders University of South Australia, Adelaide.
Insights
Preventing coronary heart disease (CHD) in primary care requires balancing patient workload with reduced morbidity and mortality. Selective screening strategies can avert CHD events, with most interventions focusing on lifestyle advice.
Area of Science:
- Cardiovascular Disease Prevention
- Primary Care Medicine
- Health Services Research
Background:
- Coronary heart disease (CHD) prevention strategies in primary care must consider both clinical outcomes and general practitioner (GP) workload.
- Estimating the effectiveness of different screening and intervention approaches is crucial for optimizing resource allocation.
Purpose of the Study:
- To compare the effectiveness of various coronary heart disease screening and intervention strategies in primary care.
- To evaluate the trade-offs between averting CHD events and the associated patient workload for GPs.
Main Methods:
- Utilized Framingham study equations to estimate CHD risks for a population of 5727 adults aged 35-64 in southern England.
- Modeled different screening strategies, from unselective to selective approaches involving varying percentages of the practice population.
- Assessed the number of avertable CHD events and the proportion of patients requiring intervention.
Main Results:
- An unselective screening approach averted 14.1% of predicted CHD events.
- Selective strategies involving 25-46% of the population averted 5.6% to 9.3% of CHD events.
- The marginal benefit of averting CHD events decreased with more inclusive screening criteria; 99% of identified individuals needed intervention, primarily lifestyle advice.
Conclusions:
- Selective screening for CHD prevention in primary care offers a balance between averting events and managing GP workload.
- Lifestyle advice is the predominant intervention required for individuals identified through selective screening.
- Optimizing CHD prevention requires careful consideration of screening intensity and intervention needs.
Abstract:
Strategies for prevention of coronary heart disease (CHD) in primary care need to take into account the number of people who require screening, further assessment, intervention and follow-up (i.e. the patient workload generated for the general practitioner) as well as the anticipated reductions in morbidity and mortality. Risks of CHD for various risk profiles were estimated from equations produced by the Framingham study. This enabled an estimate of the number of avertable CHD events to be compared against the patient workload implications for the general practitioner when different screening and intervention strategies were used. The Framingham equations were applied to a population of 5727 men and women aged 35-64 years of age registered with general practices in the south of England. Adopting an unselective approach to screening resulted in 14.1% (n = 73) of the 517 CHD events predicted over a 10 year period being averted. A limited screening strategy, involving 25% (n = 1436) of the patients would avert 5.6% (n = 29) of the predicted CHD events, whilst more extended strategies involving between 37% (n = 2131) and 46% (n = 2660) of the practice population respectively would result in between 6.9% (n = 36) and 9.3% (n = 48) of events being averted. The marginal benefit in averting CHD events decreased as more screening criteria were included. Almost all (99%) of the people identified by the selective screening strategies would require some form of intervention, predominantly lifestyle advice. Lowering the systolic blood pressure by 15 mmHg instead of 10 mmHg was equally effective as a 5% improvement in the overall rate of smoking cessation.(ABSTRACT TRUNCATED AT 250 WORDS)