Primary and secondary prevention of cardiovascular disease presents enormous opportunity and challenge for primary care. Very significant reductions in risk can be achieved with simple interventions such as smoking cessation, weight loss, blood pressure, lipid and glucose control. The number of patients involved is very large and can feel overwhelming.
CDRC has resources to support management of individual conditions, including tools to help prioritise workload e.g.
- Atrial Fibrillation (AF)
- Hypertension and Blood Pressure
- Lipid Modification
In addition CDRC has an overarching CVD prevention tool based on all CVD prevention interventions irrespective of which underlying conditions the patient does or doesn’t have. This tool gives patients a score out of 22 based on intervention potential i.e. patients are ranked on the basis of the number of interventions they might benefit from and on the size of the benefit.
Interventions are based on these groupings:
- Lifestyle intervention – e.g. smoking cessation or weight loss referral.
- Discussion about poor concordance with medication
- Assessment due or overdue e.g. due BP check, due CVD risk assessment (with higher weighting the more overdue)
- Intensification of treatment e.g. intensification of lipid or glucose lowering (with higher weighting for worse control)
- Specific drug treatments e.g. ACEi/A2RB, anticoagulation or SGLT2i
- Missed diagnoses such as diabetes, CKD, hypertension
The searches to identify these patients are found in the CDRC Population Health folder. There are 4 sets of the reports – group 1 is likely to be the most useful.
| Group | Includes palliative care and moderate/severe frailty | Includes patients who are excepted * |
| 1 | No | No |
| 2 | No | Yes |
| 3 | Yes | No |
| 4 | Yes | Yes |
* Excepted varies by intervention. Some examples include:
- Smoking cessation – has declined smoking cessation in the last 12 months
- Lipid lowering intensification – on maximally tolerated lipid Rx recorded in the last 12 months OR last cholesterol recorded in the last 14 weeks (to give chance for latest change to take effect)
- BP check overdue – BP check declined in the last 12 months
Use the CVD Prevention CDRC template to show relevant information and identify the potential interventions which are highlighted with !!
In the example above the patient might benefit from the following interventions:
- Smoking cessation referral
- Weight management referral
- Pulse rhythm check
- Discussion about concordance with lipid lowering and ACEi treatment
- Up to date assessment of lipids
- Intensification of lipid lowering treatment (pending discussion about concordance)
- Urgent intensification of antihypertensive treatment
- Consideration to setting a BP target
- Assessment of ACR to screen for CKD
The buttons on the left link to templates to look at individual areas in more detail.