Implementing the European guidelines for cardiovascular disease prevention in the primary care setting in Cyprus: Lessons learned from a health care services study

Theodora Zachariadou¹ , Henri EJH Stoffers² , Costas A Christophi³ , Anastasios Philalithis⁴ and Christos Lionis⁵

¹Nicosia Health Centre, Nicosia, Cyprus

²Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands

³Cyprus International Institute for the Environment and Public Health in association with Harvard School of Public Health, Nicosia, Cyprus

⁴Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece

⁵Department of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece

author email corresponding author email

BMC Health Services Research 2008, 8:148doi:10.1186/1472-6963-8-148


Published:	16 July 2008

Abstract

Background

Recent guidelines recommend assessment and treatment of the overall risk for cardiovascular disease (CVD) through management of multiple risk factors in patients at high absolute risk. The aim of our study was to assess the level of cardiovascular risk in patients with known risk factors for CVD by applying the SCORE risk function and to study the implications of European guidelines on the use of treatment and goal attainment for blood pressure (BP) and lipids in the primary care of Cyprus.

Methods

Retrospective chart review of 1101 randomly selected patients with type 2 diabetes mellitus (DM2), or hypertension or hyperlipidemia in four primary care health centres. The SCORE risk function for high-risk regions was used to calculate 10-year risk of cardiovascular fatal event. Most recent values of BP and lipids were used to assess goal attainment to international standards. Most updated medications lists were used to compare proportions of current with recommended antihypertensive and lipid-lowering drug (LLD) users according to European guidelines.

Results

Implementation of the SCORE risk model labelled overall 39.7% (53.6% of men, 31.3% of women) of the study population as high risk individuals (CVD, DM2 or SCORE ≥5%). The SCORE risk chart was not applicable in 563 patients (51.1%) due to missing data in the patient records, mostly on smoking habits. The LDL-C goal was achieved in 28.6%, 19.5% and 20.9% of patients with established CVD, DM2 (no CVD) and SCORE ≥5%, respectively. BP targets were achieved in 55.4%, 5.6% and 41.9% respectively for the above groups. There was under prescription of antihypertensive drugs, LLD and aspirin for all three high risk groups.

Conclusion

This study demonstrated suboptimal control and under-treatment of patients with cardiovascular risk factors in the primary care in Cyprus. Improvement of documentation of clinical information in the medical records as well as GPs training for implementation and adherence to clinical practice guidelines are potential areas for further discussion and research.