High cardiovascular risk and poor adherence to guidelines in 11,069 patients of middle age and older in primary care centres

Abstract

Background: Evaluation of the risk for fatal cardiovascular (CV) disease and adherence to guidelines in ambulatory patients in primary care centres.

Design and methods: Cross-sectional survey of risk factors and 10-year Systematic Coronary Risk Evaluation (SCORE) risk in 11,069 patients aged 50 years or more in primary care.

Results: Three-thousand, seven hundred and thirteen (33.5%) patients were actual smokers. Although 61% of the patients were treated with at least one antihypertensive drug, the mean systolic blood pressure was 141±15 mmHg. Of the treated patients, only 15.9% were at goal. Thirty-six percent of the patients were perceived as normocholesterolemic by the primary care physician. In the group of patients, presumed as hypercholesterolemic, the total cholesterol level was 235±38 mg/dl, suggesting that only very high cholesterol level was considered relevant by physicians. Virtually 0% of the patients (n=2) were treated correctly. Obesity (body mass index >30 kg/m) was found in 41% of the patients and central obesity was found in 50% of the patients. Diabetes was present in 2085 (19%) patients and at least one earlier vascular event was present in 2913 (26.3%) patients, with combined pathologies in 388 (4.5%) patients. In the remaining 6766 (61%) patients (neither diabetes nor earlier CV event), the 10-year fatal CV risk according to the Belgian SCORE table was calculated as follows: 716 (10.6%) patients had a risk of less than 2%; 1680 (24.8%) patients had a risk of 2-4%; 2576 (38%) patients had a risk of 5-9% and 1794 (26.6%) patients had a risk of 10% or more.

Conclusion: Despite simple, clear, credible guidelines, despite the existence of a simple tool such as SCORE risk scoring and despite a very accessible health system in Belgium, the CV risk remains very high even in a professional medical environment of daily primary care practice.