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. 2021 Feb 23;5(1):bjgpopen20X101139.
doi: 10.3399/bjgpopen20X101139. Print 2021 Jan.

The impact of the new Dutch guideline on cardiovascular risk management in patients with COPD: a retrospective study

Lonneke Me Nies  1 , Ingrid Looijmans-van den Akker  2 , Liesbeth Rozendaal  2 , Brenda Baar  2 , Rimke C Vos  1   3 , Huberta E Hart  4   2
Affiliations

The impact of the new Dutch guideline on cardiovascular risk management in patients with COPD: a retrospective study

Lonneke Me Nies et al. BJGP Open. .

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) have an independent increased risk of cardiovascular (CV) disease. Cardiovascular risk (CVR) assessment should be offered to all patients with COPD, according to the new Dutch CVR management (CVRM) guideline (May 2019).

Aim: To evaluate the impact of the new CVRM guideline on the care of patients with COPD in primary care.

Design & setting: A retrospective study took place within five primary healthcare centres located in The Netherlands.

Method: In accordance with the guideline, the CVR of all patients with COPD was estimated and categorised. Data from 2014-2019 were used for the qualitative risk assessment based on comorbidities, and the quantitative Systematic Coronary Risk Evaluation (SCORE). In addition, the guideline-based follow-up was investigated.

Results: Of the 391 patients with COPD, 84.1% (n = 329) had complete data on CVR assessment: 90.3% (n = 297) had a (very) high risk, and 9.7% (n = 32) a low-to-moderate risk. Of the patients with (very) high risk, 73.4% (n = 218) received guideline-based follow-up (primary care: 95.4%, secondary care: 4.6%). In 15.9% (n = 62) of all patients with COPD, the CVR profile was not measured and of the (very) high-risk patients, 26.6% (n = 79) were not enroled in a CV care programme.

Conclusion: Whereas in the majority of patients with COPD the CVR is already known, for one out of six patients this CVR still has to be assessed according to the recently updated guideline. Moreover, once a (very) high risk has been assessed, as a consequence CV treatment of risk factors should be intensified in one out of four patients with COPD. Adherence to the new CVRM guideline could provide improvement in CVRM in more than a third of all patients with COPD.

Keywords: cardiovascular diseases; health services research; primary health care; pulmonary disease, chronic obstructive; risk assessment; risk factors.

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Figures

Figure 1.
Figure 1.. Flowchart risk categories (Dutch CVRM guideline).,
ACR = albumin-creatinine ratio in urine. CV = cardiovascular. CVD = cardiovascular disease. eGFR = estimated glomerular filtration rate. SCORE = Systematic Coronary Risk Evaluation. TC = total cholesterol.
Figure 2.
Figure 2.. Flowchart: cardiovascular risks and (un)provided cardiovascular care programme. CV = cardiovascular
Figure 3.
Figure 3.. Cardiovascular risk and participation in cardiovascular-care programme of patients with COPD.
CKD = chronic kidney disease. CV-med = cardiovascular medication. CVD = cardiovascular diseases. DM = diabetes mellitus. RF = risk factors. SCORE = Systematic Coronary Risk Evaluation.
See this image and copyright information in PMC

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