Optimizing cardiovascular risk assessment and registration in a developing cardiovascular learning health care system: Women benefit most

Abstract

Since 2015 we organized a uniform, structured collection of a fixed set of cardiovascular risk factors according the (inter)national guidelines on cardiovascular risk management. We evaluated the current state of a developing cardiovascular towards learning healthcare system–the Utrecht Cardiovascular Cohort Cardiovascular Risk Management (UCC-CVRM)—and its potential effect on guideline adherence in cardiovascular risk management. We conducted a before-after study comparing data from patients included in UCC-CVRM (2015–2018) and patients treated in our center before UCC-CVRM (2013–2015) who would have been eligible for UCC-CVRM using the Utrecht Patient Oriented Database (UPOD). Proportions of cardiovascular risk factor measurement before and after UCC-CVRM initiation were compared, as were proportions of patients that required (change of) blood pressure, lipid, or blood glucose lowering treatment. We estimated the likelihood to miss patients with hypertension, dyslipidemia, and elevated HbA1c before UCC-CVRM for the whole cohort and stratified for sex. In the present study, patients included up to October 2018 (n = 1904) were matched with 7195 UPOD patients with similar age, sex, department of referral and diagnose description. Completeness of risk factor measurement increased, ranging from 0% -77% before to 82%-94% after UCC-CVRM initiation. Before UCC-CVRM, we found more unmeasured risk factors in women compared to men. This sex-gap resolved in UCC-CVRM. The likelihood to miss hypertension, dyslipidemia, and elevated HbA1c was reduced by 67%, 75% and 90%, respectively, after UCC-CVRM initiation. A finding more pronounced in women compared to men. In conclusion, a systematic registration of the cardiovascular risk profile substantially improves guideline adherent assessment and decreases the risk of missing patients with elevated levels with an indication for treatment. The sex-gap disappeared after UCC-CVRM initiation. Thus, an LHS approach contributes to a more inclusive insight into quality of care and prevention of cardiovascular disease (progression). Author summary The (inter)national guidelines for management of cardiovascular risk state that for all patients who come to a health care provider for the evaluation of their cardiovascular risk or symptoms a certain set of cardiovascular risk factors should be measured. In order to facilitate this recommendation across all hospital specialisms that take care of patients who come for the evaluation of their cardiovascular risk or symptoms, we organized in our hospital a uniform, structured collection of a fixed set of cardiovascular risk factors (the UCC-CVRM initiative) as part of a learning health care system (LHS). In the present report, we evaluated the effect of this approach on adherence to the guideline by comparing the guideline adherence before and after UCC-CVRM. We found that the adherence to the guideline improved considerably, more pronounced in women than in men. Furthermore, UCC-CVRM lead to a reduction of the risk of missing patients with elevated levels with an indication for treatment. We conclude that such an LHS approach contributes to a more inclusive insight into quality of care and prevention of cardiovascular disease (progression).