Factors Related to Cardiovascular Risk Score Reduction
Factors Related to Cardiovascular Risk Score Reduction
Cardiovascular disease (CVD) is a leading cause of death both worldwide (29% of all deaths, 2004) and in the Netherlands (28% of all deaths, 2011; Statistics Netherlands). The previously reported "Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen" randomized controlled trial (SPRING-RCT) assessed Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality in individuals with a mild to moderately elevated cardiovascular risk. This study demonstrated that one year of combined lifestyle and medication treatments by practice nurses led to a significant decrease in cardiovascular risk (Figure 1) and showed that this effect was not increased with self-monitoring.
(Enlarge Image)
Figure 1.
Distribution of ΔSCORE for all participants after one year of cardiovascular risk management (a negative number for ΔSCORE means that the estimated 10-year cardiovascular risk decreased after one year). The outlier was not included in subsequent analyses.
As treatment goals for cardiovascular risk factors are often not achieved, it is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in clinical practice. Strategies that are generally assumed to be effective include individualized risk assessment, risk communication and goal setting, and these are typically incorporated into national and international guidelines as well as research projects. These elements formed part of the treatment in both study groups of the SPRING-RCT. The main difference between the treatment groups in this study was the use of self-monitoring as a basis for feedback and counselling (intervention group). In addition, previous analysis of this data has revealed that total consultation time and the use of antihypertensive medication were higher in the intervention group.
The objective of this paper is to investigate which patient and treatment factors are related to changes in cardiovascular risk estimation in individuals with a mild to moderately elevated cardiovascular risk and who are enrolled in a programme of structured lifestyle and medication counselling with or without self-monitoring.
Background
Cardiovascular disease (CVD) is a leading cause of death both worldwide (29% of all deaths, 2004) and in the Netherlands (28% of all deaths, 2011; Statistics Netherlands). The previously reported "Self-monitoring and Prevention of RIsk factors by Nurse practitioners in the region of Groningen" randomized controlled trial (SPRING-RCT) assessed Systematic Coronary Risk Evaluation (SCORE) 10 year risk of cardiovascular mortality in individuals with a mild to moderately elevated cardiovascular risk. This study demonstrated that one year of combined lifestyle and medication treatments by practice nurses led to a significant decrease in cardiovascular risk (Figure 1) and showed that this effect was not increased with self-monitoring.
(Enlarge Image)
Figure 1.
Distribution of ΔSCORE for all participants after one year of cardiovascular risk management (a negative number for ΔSCORE means that the estimated 10-year cardiovascular risk decreased after one year). The outlier was not included in subsequent analyses.
As treatment goals for cardiovascular risk factors are often not achieved, it is important to identify patient and treatment factors that are related to successful cardiovascular risk reduction in clinical practice. Strategies that are generally assumed to be effective include individualized risk assessment, risk communication and goal setting, and these are typically incorporated into national and international guidelines as well as research projects. These elements formed part of the treatment in both study groups of the SPRING-RCT. The main difference between the treatment groups in this study was the use of self-monitoring as a basis for feedback and counselling (intervention group). In addition, previous analysis of this data has revealed that total consultation time and the use of antihypertensive medication were higher in the intervention group.
The objective of this paper is to investigate which patient and treatment factors are related to changes in cardiovascular risk estimation in individuals with a mild to moderately elevated cardiovascular risk and who are enrolled in a programme of structured lifestyle and medication counselling with or without self-monitoring.
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