Barriers to cardiovascular risk prevention and management in Germany--an analysis of the EURIKA study

Roland E Schmieder, Matthias Goebel, Peter Bramlage, Roland E Schmieder, Matthias Goebel, Peter Bramlage

Abstract

Background and purpose: Despite the availability of risk engines to determine cardiovascular risk, risk factor control is suboptimal. Using EURIKA data we compared risk factor control in Germany with that of 11 other European countries (rest of Europe [ROE]) to identify differences and opportunities for improvement.

Methods: EURIKA was a multinational, cross-sectional study in 12 European countries including Germany from May 2009 to January 2010. Physicians' attitudes to risk factor control based on the 2007 European guidelines on cardiovascular disease (CVD) prevention in a representative cohort of 7641 primary care outpatients aged ≥ 50 years with no CV disease and at least one major CV risk factor were determined.

Results: Compared to the ROE, German physicians were more frequently male (72.7% vs 62.6%), had a higher mean age (51.7 ± 8.4 vs 47.0 ± 9.7 years), faced higher patient loads (37.9% vs 16.5% had >199 patients/week), and involved other health sector professionals (dieticians, psychologists) less (31.8% vs 41.0% in the ROE). The European Society of Cardiology (ESC) guidelines on CVD prevention were more important for German physicians (60.6% vs 55.9%), while those who didn't use them gave reasons for nonuse as too many (62.5% vs 46.2%), too confusing, unrealistic, or not applicable to their patients. Risk engines were used less (54.5% vs 70.7%), with perceived lack of time (65.5% vs 60.2%) a frequent reason for nonuse. Risk factor control in German patients was inadequate (control rates: hypertension 36.3%, dyslipidemia 30.4%, type 2 diabetes 40.6%, obesity 28.8%) but largely comparable to other ROE countries; however, physicians tended to overestimate control rates.

Conclusion: EURIKA provides comprehensive data on the status of primary prevention of CVD in clinical practice in Germany and reveals considerable potential for improving the primary prevention of CVD.

Trial registration: ClinicalTrials.gov NCT00882336.

Keywords: cardiovascular risk factor; primary care.

Figures

Figure 1
Figure 1
Physicians’ use of guidelines for the management of cardiovascular risk factors. Notes: ESC CVD Prevention, European Society of Cardiology (ESC) Guideline on Cardiovascular Disease Prevention in Clinical Practice; ESC/ESH Hypertension, ESC Guideline for the Management of Arterial Hypertension; ATP III, Adult Treatment Panel III; JNC VII, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.–, Other guidelines not specified.
Figure 2
Figure 2
Physicians’ use of global risk assessment tools (of those using these tools). Notes: ESC Score; ESC/ESH Hypertension, ESC Guideline for the Management of Arterial Hypertension; Framingham study; Framingham Coronary Risk Score.,,, *Locally calibrated version of the Framingham study score. Other guidelines not specified.
Figure 3
Figure 3
Control of treated hypertension (1c < 6.5%), and obesity (BMI < 30 kg/m2) in special countries versus the average control rate in all countries. Notes: *Patients with diabetes: <130/80 mm Hg; <4.5 mmol/L, and <2.5 mmol/L (100 mg/dL). Abbreviations: BEL, Belgium; FRA, France; GER, Germany; GRE, Greece; UK, United Kingdom; DL, dyslipidemia; DM, diabetes mellitus; HT, hypertension; OBES, obesity.

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