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Targeted case finding in the prevention of cardiovascular disease : a stepped wedge cluster randomised controlled trial
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Hemming, Karla, Ryan, R., Gill, Paramjit, Westerby, P., Jolly, K. and Marshall, T. (2016) Targeted case finding in the prevention of cardiovascular disease : a stepped wedge cluster randomised controlled trial. British Journal of General Practice, 66 (651). e758-e767. doi:10.3399/bjgp16X686629 ISSN 0960-1643.
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Official URL: http://dx.doi.org/10.3399/bjgp16X686629
Abstract
Background Individuals at high risk of cardiovascular disease (CVD) are undertreated.
Aim To evaluate the effectiveness of a programme of targeted, nurse-led case finding for CVD prevention in primary care.
Design and setting Targeted case finding for CVD prevention was implemented in urban West Midlands general practices between February 2009 and August 2012, and evaluated as a stepped wedge cluster randomised trial.
Method Untreated patients aged 35–74 years and at ≥20% 10-year CVD risk were identified, invited for assessment by a project nurse, and referred to their GP for treatment initiation. The primary outcome was the proportion of high-risk patients prescribed antihypertensives or statins after exposure to the intervention compared with an equivalent period of time prior to exposure. Secondary outcomes included assessment of CVD risk factors.
Results In 26 sequentially randomised general practices the exposed group consisted of 2926 untreated high-risk patients identified at the start of the intervention, with 2969 patients identified at the start of the unexposed period. The trial was well balanced in terms of age, sex, and cardiovascular risk factors. In the exposed period 19.7% of patients were prescribed antihypertensives or statins, and 10.8% of patients in the unexposed period. After adjustment for clustering and temporal effects the risk difference was 15.5% (95% CI = 3.9 to 27.1, P = 0.009). Assessment of lipid levels increased significantly, at 26.4% (99% CI = 5.3 to 47.5, P = 0.001)
Conclusion Targeted case finding programmes can increase the number of high-risk patients started on antihypertensive and statin treatment.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| Journal or Publication Title: | British Journal of General Practice | ||||||
| Publisher: | Royal College of General Practitioners | ||||||
| ISSN: | 0960-1643 | ||||||
| Official Date: | October 2016 | ||||||
| Dates: |
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| Volume: | 66 | ||||||
| Number: | 651 | ||||||
| Page Range: | e758-e767 | ||||||
| DOI: | 10.3399/bjgp16X686629 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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