Health & Medical Heart Diseases

Preventing Cardiovascular Disease in Primary Care

Preventing Cardiovascular Disease in Primary Care

Abstract and Introduction

Abstract


Background Heartwatch, a structured risk factor modification program for secondary prevention of cardiovascular (CV) disease (CVD) in primary care, is associated with improvements in CV risk factors in participating patients. However, it is not known whether Heartwatch translates into reductions in clinically important CV events.
Objective The aim of the study was to determine the association between participation in Heartwatch and future risk of CV events in patients with CVD.
Methods The study consisted of a prospective cohort of 1,609 patients with CVD in primary care practices. Of these, 97.5% had data available on Heartwatch participation status, of whom 15.2% were Heartwatch participants. Cox proportional hazards models were used to determine the association between Heartwatch participation and risk of the CV composite (CV death, nonfatal myocardial infarction, heart failure, and nonfatal stroke). All-cause mortality and CV mortality were secondary outcome measures.
Results During follow-up, the CV composite occurred in 208 patients (13.6%). Of Heartwatch participants, 8.4% experienced the CV composite compared with 14.5% of nonparticipants (P = .003). Participation in Heartwatch was associated with a significantly reduced risk of the CV composite (hazard ratio [HR] 0.52, 95% CI, 0.31–0.87), CV mortality (HR 0.31, 95% CI, 0.11–0.89), and all-cause mortality (HR 0.32, 95% CI, 0.15–0.68). Heartwatch participation was also associated with greater reductions in mean systolic blood pressure (P = .047), mean diastolic blood pressure (P < .001), and greater use of secondary preventative therapies for CVD, such as lipid-lowering agents (P < .001), β-blockers (P < .001), and angiotensin-converting enzyme inhibitors (P < .001).
Conclusion Heartwatch is associated with a reduced risk of major vascular events and improved risk factor modification, supporting its potential as a nationwide program for secondary prevention of CVD.

Introduction


Cardiovascular (CV) disease (CVD) is one of the leading causes of mortality worldwide. Individuals with established CVD are at a significantly increased risk of subsequent CV events, such as stroke, myocardial infarction, and CV death. Heartwatch, a structured primary care delivered program for the secondary prevention of coronary heart disease in Ireland, was introduced in 2003 and follows the recommendations of the European Joint Task Force on Coronary Prevention. Previous studies evaluating the Heartwatch program have reported significant reductions in systolic blood pressure (SBP), diastolic blood pressure (DBP), proportion of individuals smoking, total cholesterol (TC), and low-density lipoprotein cholesterol levels as well as significant increases in the use of secondary preventative therapies, such as lipid-lowering agents and antihypertensive medications, in participating patients. However, neither of these studies included a control group for comparison. Furthermore, there have been no studies to date that have evaluated whether Heartwatch-related improvements in vascular risk factors translate into reductions in clinically important CV events such as myocardial infarction, stroke, or CV-related mortality. Given the cost and logistic challenges associated with implementing the Heartwatch program, such information is important in informing policy for CVD prevention in primary care.

Within a population-based prospective cohort study, we determined the association between a primary care–;based intervention (Heartwatch) and future risk of major vascular events in patients with established CVD followed up for approximately 3 years.

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