Is a targeted and planned GP intervention effective in cardiovascular disease prevention? A randomized controlled trial
Ksenija Kranjčević, Biserka Bergman Marković, Dragica Ivezić Lalić, Davorka Vrdoljak, Jasna Vučak
General Practice Office, Zagreb-Zapad Health Care Center, Zagreb, Croatia
Med Sci Monit 2014; 20:1180-1187
The optimal intensity and duration of the intervention to achieve sustained risk reduction in patients at high and very high cardiovascular (CV) risk still need to be established. The aim of this study was to evaluate the impact of general practitioner’s (GP’s) systematic and planned intervention on total CV risk reduction and a change in individual CV risk factors.
Material and Methods: This was a cluster-randomized trial (ISRCTN31857696) including 64 practices and 3245 patients aged ≥40. The participating GPs and their examinees were randomized into an intervention or to a control group (standard care). Intervention group practitioners followed up their examinees during 1, 3, 6, 12, and 18 months. The main outcome measures were change in proportion of patients with low, moderate, high, and very high CV risk, and change in individual CV risk factors from the first to the second registration.
Results: The proportion of patients with very high CV risk was lower in the intervention group, the same as of patients with high blood pressure, total and LDL cholesterol, and increased intake of alcohol. The mean systolic (–1.49 mmHg) and diastolic (–1.57 mmHg) blood pressure, triglycerides (–0.18 mmol/L), body mass index (–0.22), and waist (–0.4 cm) and hip circumference (–1.08 cm) was reduced significantly in the intervention group. There was no additional impact in the intervention group of other tested CV risk factors.
Conclusions: Systematic and planned GP’s intervention in CVD prevention reduces the number of patients with very high total CV risk and influences a change in lifestyle habits.
Keywords: Cardiovascular Diseases - prevention & control, Adult, Case-Control Studies, general practitioners, Risk Factors