The effect of feedback on cardiovascular risk factors on optimization of primary prevention: The PharmLines initiative

Abstract

Background: It is unknown whether population based single assessment of cardiovascular disease (CVD) risk and feedback to individuals and general practitioners results in initiation of preventive cardiovascular pharmacotherapy in those at risk.

Methods: The population based cohort study Lifelines was linked to the IADB.nl pharmacy database to assess information on the initiation of preventive medication (N = 48,770). At the baseline visit, information on cardiovascular risk factors was collected and reported to the participants and their general practitioners. An interrupted-time-series-analysis was plotted, in which the start year of blood pressure and lipid lowering medication was displayed in years before or after the baseline visit. Subsequently, predictors of the initiation of pharmacotherapy were determined and possible reduction in cardiovascular events that could be achieved by optimal treatment of individuals at risk.

Results: Before the Lifelines baseline visit, 34% (out of 1,527, 95% Confidence interval (CI) 32%-36%) and 30% (out of 1,991, 95%CI 28%-32%) of the individuals at risk had a blood pressure or lipid lowering drug prescription, respectively. In those at risk, the use of blood pressure lowering medication, increased substantially during the year of the baseline visit. Treating individuals at increased risk (≥5% 10-year risk) with lipid or blood pressure lowering medication (N = 8515 and N = 6899) would have prevented 162 and 183 CVD events, respectively, in the upcoming five years.

Conclusion: Primary prevention of CVD in the general population appears suboptimal. Feedback of cardiovascular risk factors resulted in a substantial increase of blood pressure lowering medication and extrapolated health benefits.

Keywords: Cardiovascular disease; Lifelines; Primary prevention; Risk assessment; Risk factors.

Fig. 1

Flowchart of the study population. N = number.

Fig. 2

Interrupted time series analysis. On the Y-axis the percentages of treated individuals in whom treatment is recommended and the control group are displayed. On the X-axis the start year of preventive medication is displayed. The light blue vertical line is the year of the baseline visit. Continues lines represent the start of medication in individuals at risk. Dashed lines represent the start of medication in the control group (individuals without a recommendation for preventive medication). BL = baseline.