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[How well are patients with atherosclerosis treated in general practice? Risk factors and intervention surveyed in
A Svilaas1, A Westheim, J E Kristoffersen
1Nymoen legekontor, Kongsberg.
Insights
Despite increased use of lipid-lowering agents for patients with atherosclerotic disease, LDL-cholesterol levels remain suboptimal. Effective intervention strategies and collaboration between general practitioners and specialists are crucial for improved patient outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
- General Practice
Background:
- Coronary heart disease (CHD) and peripheral arterial disease (PAD) are significant health concerns.
- Risk factor management and treatment adherence are critical for secondary prevention in these patients.
Purpose of the Study:
- To assess risk factors and treatment patterns in patients with CHD and PAD.
- To evaluate the effectiveness of current management strategies in general practice settings.
Main Methods:
- A screening study involving 1,353 patients across 63 general practices.
- Data collection focused on patient demographics, risk factors (smoking), and prescribed medications (lipid-lowering agents, antithrombotics, beta-blockers).
- Assessment of LDL-cholesterol levels and blood pressure control against recommended targets.
Main Results:
- A significant increase in lipid-lowering agent prescriptions was observed compared to previous screenings (55% vs. 18%).
- Despite treatment, 83% of patients exceeded the recommended LDL-cholesterol level of ≤2.6 mmol/l.
- Treatment with antithrombotics, beta-blockers, and blood pressure control were found to be unsatisfactory.
- Lipid-lowering agents were prescribed more frequently, and aspirin less frequently, than in comparable European surveys.
Conclusions:
- Current management of atherosclerotic disease in primary care requires improvement, particularly in achieving lipid targets.
- Enhanced collaboration between general practitioners and specialists is essential for developing and implementing effective intervention strategies.
- Further research into optimizing treatment protocols for patients with CHD and PAD is warranted.
Abstract:
In 1996 and 97, a total of 1,353 patients with coronary heart disease and peripheral arterial disease were screened in 63 general practices for their specific risk factors and treatment. 63% of the patients were males and 25% were smokers. 55% of the patients had been prescribed a lipid lowering agent, in most cases by their general practitioner, as opposed to 18% in a similar screening in 1994 and 95. This corresponds with a general increase in the number of prescriptions for this kind of drug. The majority of patients treated were 75 years of age and under. The recommended level of LDL-cholesterol in secondary prevention is 2.6 mmol/l or less. 83% of the patients had values above this level. Neither the treatment with antithrombotic agents and beta-blockers, nor the reduction in the systolic blood pressure in hypertensive patients was found to be satisfactory. The same lipid profile and frequency with which drugs were prescribed was seen in both diabetic and non-diabetic patients. We found that lipid lowering agents were prescribed more frequently and aspirin less frequently than in comparable European surveys. It is essential to develop effective intervention strategies and for general practitioners and specialists to collaborate closely to implement these strategies for patients with atherosclerotic disease.