Nies Lonneke Me, Akker Ingrid Looijmans-van den, Rozendaal Liesbeth, Baar Brenda, Vos Rimke C, Hart Huberta E
Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Leidsche Rijn Julius Healthcare Centers, Utrecht, The Netherlands.
BJGP Open. 2021 Feb 23;5(1). doi: 10.3399/bjgpopen20X101139. Print 2021 Jan.
Patients with chronic obstructive pulmonary disease (COPD) have an independent increased risk of cardiovascular (CV) disease. Cardiovascular risk (CVR) assessment should be offered to all patients with COPD, according to the new Dutch CVR management (CVRM) guideline (May 2019).
To evaluate the impact of the new CVRM guideline on the care of patients with COPD in primary care.
DESIGN & SETTING: A retrospective study took place within five primary healthcare centres located in The Netherlands.
In accordance with the guideline, the CVR of all patients with COPD was estimated and categorised. Data from 2014-2019 were used for the qualitative risk assessment based on comorbidities, and the quantitative Systematic Coronary Risk Evaluation (SCORE). In addition, the guideline-based follow-up was investigated.
Of the 391 patients with COPD, 84.1% ( = 329) had complete data on CVR assessment: 90.3% ( = 297) had a (very) high risk, and 9.7% ( = 32) a low-to-moderate risk. Of the patients with (very) high risk, 73.4% ( = 218) received guideline-based follow-up (primary care: 95.4%, secondary care: 4.6%). In 15.9% ( = 62) of all patients with COPD, the CVR profile was not measured and of the (very) high-risk patients, 26.6% ( = 79) were not enroled in a CV care programme.
Whereas in the majority of patients with COPD the CVR is already known, for one out of six patients this CVR still has to be assessed according to the recently updated guideline. Moreover, once a (very) high risk has been assessed, as a consequence CV treatment of risk factors should be intensified in one out of four patients with COPD. Adherence to the new CVRM guideline could provide improvement in CVRM in more than a third of all patients with COPD.
慢性阻塞性肺疾病（COPD）患者患心血管（CV）疾病的风险独立增加。根据新的荷兰心血管风险管理（CVRM）指南（2019年5月），应向所有COPD患者提供心血管风险（CVR）评估。
评估新的CVRM指南对初级保健中COPD患者护理的影响。
在荷兰的五个初级医疗保健中心进行了一项回顾性研究。
根据指南，对所有COPD患者的CVR进行估计和分类。2014年至2019年的数据用于基于合并症的定性风险评估和定量系统性冠状动脉风险评估（SCORE）。此外，还调查了基于指南的随访情况。
在391例COPD患者中，84.1%（n = 329）有完整的CVR评估数据：90.3%（n = 297）为（非常）高风险，9.7%（n = 32）为低至中度风险。在（非常）高风险患者中，73.4%（n = 218）接受了基于指南的随访（初级保健：95.4%，二级保健：4.6%）。在所有COPD患者中，15.9%（n = 62）未测量CVR概况，在（非常）高风险患者中，26.6%（n = 79）未纳入心血管护理计划。
虽然大多数COPD患者的CVR已经明确，但仍有六分之一的患者需要根据最新指南评估CVR。此外，一旦评估为（非常）高风险，四分之一的COPD患者应加强对风险因素的心血管治疗。遵循新的CVRM指南可使超过三分之一的COPD患者的CVRM得到改善。
