Primary cardiovascular prevention: Effects of two different interventions on management of patients with hypertension and high global cardiovascular risk.
Mortsiefer A1, Meysen T1, Schumacher M1, Lintges C1, Stamer M2, Schmacke, N2, Wegscheider K3, Abholz HH1, in der Schmitten J1,
1Department of General Practice, University Hospital, P.O. Box 101001, 40225 Düsseldorf, Germany
2 Health Systems Research Chair (AKG), University of Bremen, Bibliothekstr. 1, 28359 Bremen, Germany
3Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
Aims and purpose:
To compare the effect of a simple versus a complex educational intervention on management of patients with known hypertension at high cardiovascular risk (CVR) in primary prevention.
Methods/design:
Prospective longitudinal cluster-randomised intervention trial with 94 GPs consecutively enrolling 40 patients each with known hypertension. All GPs received a written manual specifically developed to transfer the concept of global CVR into daily practice. After cluster-randomisation, half of GPs additionally received a clinical outreach visit by a trained peer. Main outcome measure was the improvement of calculated CVR in patients with high CVR in primary prevention, defined as 10-year-mortality ³ 5% according to the European SCORE formula, six months after intervention
Results:
1602 patients (48% of the overall study population) were at high cardiovascular risk (SCORE ? 5%) with no history of cardiovascular disease. For this patients we found significant reduction of CVR in the “simple intervention group” (from 14,3% to 13,4%) as well in the “complex intervention group” (from 13,4% to 12,3%). However no significant difference between both intervention groups could be observed. The hypertension control rate (RR<140/90 mmHg) increased significant in both intervention groups from approximately 37% to 46% with no significant differences between the two groups.
Conclusions:
We found no additional effect of the complex intervention compared to the simple intervention. Similar improvements in both groups may indicate causal effects of both interventions but may also influenced by higher attention of GP’s on cardiovascular prevention within study participation or by external factors like the implementation of disease management programs in Germany.