Zachariadou Theodora, Stoffers Henri E J H, Christophi Costas A, Philalithis Anastasios, Lionis Christos
Nicosia Health Centre, Nicosia, Cyprus.
BMC Health Serv Res. 2008 Jul 16;8:148. doi: 10.1186/1472-6963-8-148.
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.
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.
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 > or =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 > or =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.
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.
近期指南建议通过管理绝对风险较高患者的多种风险因素来评估和治疗心血管疾病（CVD）的总体风险。我们研究的目的是应用SCORE风险函数评估已知CVD风险因素患者的心血管风险水平，并研究欧洲指南对塞浦路斯初级保健中血压（BP）和血脂治疗及目标达成情况的影响。
对四个初级保健健康中心随机选取的1101例2型糖尿病（DM2）、高血压或高脂血症患者进行回顾性病历审查。使用高风险地区的SCORE风险函数计算心血管致命事件的10年风险。使用BP和血脂的最新值评估是否达到国际标准目标。使用最新的药物清单比较根据欧洲指南当前使用推荐的抗高血压和降脂药物（LLD）使用者的比例。
实施SCORE风险模型后，研究人群中总体有39.7%（男性为53.6%，女性为31.3%）被标记为高风险个体（CVD患者、DM2患者或SCORE≥5%）。由于患者记录中缺少数据（主要是吸烟习惯数据），SCORE风险图不适用于563例患者（51.1%）。已确诊的CVD患者、DM2（无CVD）患者和SCORE≥5%的患者中，分别有28.6%、19.5%和20.9%的患者实现了低密度脂蛋白胆固醇（LDL-C）目标。上述三组患者的血压目标达成率分别为55.4%、5.6%和41.9%。所有三个高风险组的抗高血压药物、LLD和阿司匹林均存在处方不足的情况。
本研究表明，塞浦路斯初级保健中具有心血管风险因素的患者控制不佳且治疗不足。改善病历中临床信息的记录以及对全科医生进行实施和遵守临床实践指南的培训是值得进一步讨论和研究的潜在领域。
