Ndede Kevin O, Khan Zahid, Akumiah Florence K, Wanyoike Martin
Internal Medicine/Medical Physiology, Kenya Methodist University, Nairobi, KEN.
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cureus. 2023 Sep 27;15(9):e46097. doi: 10.7759/cureus.46097. eCollection 2023 Sep.
Introduction Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. It is projected that the prevalence of CVD will continue to rise in developing countries, largely driven by an increase in the prevalence of potentially modifiable risk factors. Atherosclerotic cardiovascular risk assessment among individuals with risk factors for CVD but without CVD is an inexpensive and viable strategy in CVD risk stratification and prevention. Despite the known benefits of CVD risk assessment, it is not well established whether physicians/ cardiologists in Kenya comply with the guideline-recommended practice of CVD risk stratification as a prerequisite for initiation of primary CVD preventive interventions. Aims and objectives This study was designed to audit the utilization of cardiovascular risk assessment tools in risk stratification of hypertensive individuals and physician provision of risk-based primary CVD prevention interventions. Results A five-year (2017-2022) retrospective study of patients' medical records was conducted in December 2022 at the PrimeCare cardiology clinic in Nairobi Hospital, Kenya. Data were collected from 373 patients' medical records retrospectively. The data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). The mean age of the patients was 60 years with the majority being female (54%). The mean BMI was 30.3 kg/m while the mean systolic and diastolic pressure was 140mmHg and 80mmHg, respectively. Only 2.1% of participants were current smokers. The national or alternative guideline-recommended CVD risk assessment tool was used in 0.3% and 2.4%, respectively. The 10-year CVD risk score was documented in only 1.3%. The majority of the participants (93%) had low CVD risk. Half of the patients were taking statins for primary prevention while > 60% of them had been offered therapeutic lifestyle advice. Conclusion The study revealed poor compliance with guideline-recommended CVD risk assessment tools and documentation of the CVD risk level. However, there was above-average adherence to documentation of therapeutic lifestyle measures for primary CVD prevention.
引言
心血管疾病（CVD）是全球发病和死亡的主要原因。预计在发展中国家，心血管疾病的患病率将持续上升，这在很大程度上是由潜在可改变的风险因素患病率增加所驱动的。对有心血管疾病风险因素但无心血管疾病的个体进行动脉粥样硬化心血管风险评估，是心血管疾病风险分层和预防中一种经济可行的策略。尽管心血管疾病风险评估有已知的益处，但肯尼亚的医生/心脏病专家是否遵循指南推荐的心血管疾病风险分层做法作为启动原发性心血管疾病预防干预措施的前提条件，目前尚不明确。
目的
本研究旨在审核心血管风险评估工具在高血压个体风险分层中的使用情况，以及医生提供基于风险的原发性心血管疾病预防干预措施的情况。
结果
2022年12月，在肯尼亚内罗毕医院的PrimeCare心脏病诊所对患者病历进行了一项为期五年（2017 - 2022年）的回顾性研究。回顾性收集了373例患者的病历数据。使用IBM SPSS Statistics for Windows，版本25（2017年发布；IBM公司，美国纽约州阿蒙克）对数据进行分析。患者的平均年龄为60岁，大多数为女性（54%）。平均体重指数为30.3 kg/m，平均收缩压和舒张压分别为140mmHg和80mmHg。只有2.1%的参与者为当前吸烟者。分别有0.3%和2.4%的患者使用了国家或替代指南推荐的心血管疾病风险评估工具。仅1.3%的患者记录了10年心血管疾病风险评分。大多数参与者（93%）心血管疾病风险较低。一半的患者正在服用他汀类药物进行一级预防，而超过60%的患者已获得治疗性生活方式建议。
结论
该研究显示，对指南推荐的心血管疾病风险评估工具的依从性较差，且心血管疾病风险水平的记录情况不佳。然而，在原发性心血管疾病预防治疗性生活方式措施的记录方面，依从性高于平均水平。
