European Heart Journal Advance Access published online on November 19, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm520
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Achievement of guideline-defined treatment goals in primary care: the German Coronary Risk Management (CoRiMa) study
1 Division of Cardiology, Zentralklinik Bad Berka, Robert Koch Allee 9, 99437 Bad Berka, Germany
2 Pfizer Pharma GmbH, Germany
3 StatConsult Gesellschaft für klinische und Versorgungsforschung, Magdeburg, Germany
4 Institut für Epidemiologie und Sozialmedizin, University Hospitals Münster, Germany
5 Institut für Biometrie und Medizinische Informatik, University Hospitals Magdeburg, Germany
6 Diabetes Center, Essen, Germany
7 Diabetes Center, Offenburg, Germany
8 University Hospitals Charité, Berlin, Germany
Received 26 June 2007; revised 11 October 2007; accepted 18 October 2007.
* Corresponding author. Tel: +49 36458 51201; fax: +49 36458 53506. E-mail address: c.geller.kar{at}zentralklinik-bad-berka.de
Aims: The success in achieving treatment goals for cardiovascular risk factors in primary care is largely unknown. Therefore, the goals of this study were (i) to assess whether routinely collected practice data can be used to evaluate treatment in primary care, (ii) to compare current treatment with goals of published guidelines, and (iii) to calculate future risk for cardiovascular events using these real-life data.
Methods and results: In 110 physician offices in Germany, data from the patient management systems of all patients seen between January 1998 and June 2005 were extracted and analysed (715 644) with current guidelines used for reference. Of those patents, 284 096 (40% of all patients analysed) had one of the following diseases: 157 101 (55% of 284 096) had hypertension, 83 005 (29%) diabetes, 64 205 (23%) coronary artery disease (CAD), 174 787 (62%) hyperlipidaemia, and 136 360 (48%) had more than one of the listed diagnoses. During the last visit, treatment goals were achieved for total and LDL cholesterol in 9 and 29%, respectively, for blood pressure in 28%, and for HbA1c in 36%. Low achievement of treatment goals was also seen in patients with CAD or diabetes. Using the Framingham risk model and the SCORE Deutschland risk charts, 20 and 22% of patients had a high 10-year risk for a primary cardiovascular event and a fatal cardiovascular event, respectively. Achieving treatment goals for all risk factors would significantly reduce the number of high-risk patients.
Conclusion: (i) Routinely collected practice data can be used to evaluate quality of care; (ii) 40% of patients in primary care have cardiovascular disease or diabetes; (iii) even in high-risk patients, the majority does not achieve treatment goals; and (iv) achieving the treatment goals would reduce the proportion of high-risk patients from 20 to <5%.
Key Words: Coronary artery disease • Hypertension • Diabetes • Hyperlipidaemia • Risk factors • Primary care • Risk modelling
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