Experts behind a large pan-European study believe that through better identification and management of traditional risk factors for cardiovascular disease, such as hypertension, diabetes, dyslipidaemia, and obesity, a large proportion of coronary deaths across Europe could be avoided. The first results from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) announced on 8 November 2010 identified several common barriers which limit physician use of cardiovascular risk assessment tools and clinical guidelines.
“These findings confirm that despite the European Society of Cardiology (ESC) guidelines on cardiovascular prevention and the availability of a variety of risk assessment tools, risk factors are not adequately controlled which may lead to excess cardiovascular mortality across Europe,” said Jean Dallongeville from the Institut Pasteur de Lille, Lille Cedex, France, a member of the EURIKA Steering Committee.
EURIKA was an observational study which assessed level of control of the main risk factors for cardiovascular disease according to the European guidelines on cardiovascular disease prevention. The study included 7,641 patients over 50 years of age (mean age 63.2 years) who were free from cardiovascular disease, but had at least one risk factor as defined by the ESC 2007 guidelines. In addition, 806 physicians were surveyed to investigate their daily management of traditional cardiovascular risk factors, including the use of cardiovascular risk assessment tools and guidelines, and explore factors limiting their use. Findings were announced at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) annual meeting.
Key findings demonstrate the need for better preventive care for at-risk patients
The EURIKA Steering Committee estimated that the adjusted excess mortality attributable to each cardiovascular disease risk factor was 17% for current smokers, 23% for those with hypertension, 26% for those with dyslipidaemia and 30% for those with diabetes, based on the NHANES III survey model.
Results showed that amongst patients being treated for a traditional risk factor of cardiovascular disease, 60% did not have their risk factor adequately controlled according to the standards set by European guidelines. Approximately one third of patients in the EURIKA study were considered to be at a high risk of fatal cardiovascular disease.
Cardiovascular risk was calculated using SCORE (Systematic COronary Risk Evaluation), the cardiovascular disease risk assessment system initiated by the ESC.
Increased physician compliance may decrease avoidable coronary deaths
As many as 30% of doctors said they did not use risk assessment tools at all due to time constraints (59.8%), finding the tools of little use (21.7%), not knowing how to use the tools (19.7%), and not knowing what to do after risk assessment (4.1%).
Furthermore, nearly 13% of doctors said they did not follow guidelines on the management of cardiovascular risk, citing uncertainty of which to use (47.5%), time constraints (33.7%), lack of knowledge (27.7%) and a perception that they are unrealistic (23.8%) as common factors limiting their use.
Julian Halcox, Cardiff University, UK, another member of the EURIKA steering committee, concluded: “We know that effective assessment and treatment of risk factors for cardiovascular disease and following guidelines for best practice in this important area can reduce the number of avoidable heart attacks strokes and cardiovascular disease deaths. This is of benefit not only to patients and their families but can potentially relieve a serious strain on health budgets. The findings of EURIKA provide real-world, practice-based insights for leaders in cardiology, national health authorities and industry to help guide public health strategy across Europe.”
Further data from the EURIKA study, including a country-by-country breakdown of results, are expected in 2011.
The study was funded by AstraZeneca.