. 2024 Dec 5;19(12):e0312137.

doi: 10.1371/journal.pone.0312137. eCollection 2024.

Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

Kiran Bam¹, Muideen T Olaiya¹, Dominique A Cadilhac^{1

2}, Julie Redfern^{3

4

5}, Mark R Nelson^{6

7}, Lauren M Sanders^{8

9}, Vijaya Sundararajan¹⁰, Nadine E Andrew^{11

12}, Lisa Murphy¹³, Monique F Kilkenny^{1

2}

Affiliations

¹ Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
² Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ The George Institute for Global Health, Sydney, New South Wales, Australia.
⁵ Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia.
⁶ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁷ School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
⁸ Department of Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁹ Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia.
¹⁰ Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Heidelberg, Victoria, Australia.
¹¹ Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
¹² National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia.
¹³ Stroke Foundation, Melbourne, Victoria, Australia.

PMID: 39637114
PMCID: PMC11620663
DOI: 10.1371/journal.pone.0312137

Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

Kiran Bam et al. PLoS One. 2024.

. 2024 Dec 5;19(12):e0312137.

doi: 10.1371/journal.pone.0312137. eCollection 2024.

Authors

Affiliations

¹ Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
² Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
³ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ The George Institute for Global Health, Sydney, New South Wales, Australia.
⁵ Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia.
⁶ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
⁷ School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
⁸ Department of Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁹ Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia.
¹⁰ Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Heidelberg, Victoria, Australia.
¹¹ Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
¹² National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia.
¹³ Stroke Foundation, Melbourne, Victoria, Australia.

PMID: 39637114
PMCID: PMC11620663
DOI: 10.1371/journal.pone.0312137

Abstract

Background: Primary care is usually the entry point for preventing cardiovascular disease (CVD). Quality indicators can be used to assess and monitor the quality of care provided in a primary care setting. In this systematic review, we aimed to identify, summarise, and assess the methodological quality of indicators reported in the articles for the primary prevention of CVD in primary care.

Methods: We searched Ovid MEDLINE, Ovid EMBASE, CINAHL Plus, SCOPUS, and grey literature for articles containing quality indicators published in English language. Quality indicators were categorised using the Donabedian framework: Structure (organisation of care), Process (assessment of metabolic risk factors, global risk assessment, lifestyle management, prescription of medications, risk communication/advice, referral), and Outcome (attainment of risk factor targets). Articles were reviewed by two authors, using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, where a score of ≥50% for each domain indicated strong methodological quality (e.g., stakeholder involvement).

Results: We identified 282 articles for full-text review; 57 articles were included for extraction. A total of 726 (681 unique) quality indicators were extracted. Three out of four (76%) were process indicators (56 articles), followed by 15% outcome indicators (40 articles), and 9% structure indicators (12 articles). One-third of process indicators were related to the assessment of metabolic risk factors (222/726 indicators, 41 articles), followed by lifestyle management (153/726 indicators, 39 articles), prescription of medications (122/726 indicators, 37 articles), and global risk assessment (27/726, 14 articles). Few indicators were related to risk communication/advice (20/726 indicators, 7 articles) and referral (9/726 indicators, 6 articles). Only 26/57 (46%) articles were found to have strong methodological quality.

Conclusion: We summarised and appraised the methodological quality of indicators for the primary prevention of CVD. The next step requires prioritising a minimum set of quality indicators to encourage standardised collection and monitoring across countries.

Copyright: © 2024 Bam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Conflict of interest statement

Dominique A Cadilhac received restricted grants from Boehringer Ingelheim, Moleac, Amazon Web Services, Nicolab, Philips and Medtronic; outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

**Fig 1. PRISMA 2020 flowchart for identification and inclusion of articles.**

**Fig 2. Conceptual framework indicating the domains of primary care services for cardiovascular disease prevention.**

**Fig 3. Heat map presenting appraisal of articles by AIRE instrument and score by domains.**

See this image and copyright information in PMC

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Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

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Quality indicators for the primary prevention of cardiovascular disease in primary care: A systematic review

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