Integrated cardiovascular risk management programme versus usual care in high CV risk patients: an observational study in general practice.

Background Cardiovascular diseases (CVD) are the leading cause of death and cardiovascular (CV) risk factors are often insufficiently controlled in high risk patients. Recently, integrated multidisciplinary cardiovascular risk management (CVRM) programmes were introduced in primary care. Aim The present study investigates the effects of a CVRM programme on systolic blood pressure (SBP) and LDL-cholesterol. Design & setting A prospective observational study, in high CV risk patients aged 40-80 years in general practice, comparing integrated CVRM care with usual care. Method Intervention and usual care patients were matched at baseline on age, gender and presence of CVD. During one year of follow-up patients received integrated or usual CVRM care in general practice. Primary outcomes were SBP and LDL-cholesterol. Secondary outcomes included calculated 10-year CV risk, BMI, lifestyle (smoking, physical activity, dietary habits), medication use, patient satisfaction, health care consumption, morbidity, comorbidity and mortality. We used mixed-model analyses to assess the outcomes. Results We included 372 and 317 patients in the intervention and usual care group, respectively. Mean age at baseline was 65.1 and 66.2 years respectively and 42% were women in both groups. After one year, we observed no difference in SBP (137.2 mmHg vs 139.0 mmHg in the intervention and usual care group, respectively) and LDL-cholesterol (2.6 mmol/L in both groups), nor in any of the secondary outcomes. Conclusion Integrated CVRM care in general practice did not lead to a lower SBP or LDL-cholesterol in patients at high CV risk. Further research is needed to improve CVRM.