|Date defended||February 19, 2019|
|(Co-) Supervisors||Prof. Dr D.E. Grobbee, Dr C.H. Vaartjes, Dr K. Klipstein-Grobusch|
|Title of thesis||SUrvey of Risk Factors in Coronary Heart Disease (SURF CHD): A clinical audit programme of cardiovascular risk factor management in daily practice|
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Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. The top priority of secondary prevention is to control modifiable risk factors. However, current cardiovascular risk factor management remains inadequate and monitoring programs, like clinical audits, are lacking. Objectives: i> to summarize the importance of clinical audits in daily practice; ii> to describe CVD risk factor recording and management in routine practice; iii> to assess potential determinants within and between different geographic regions; and iv> to summarize the use of cardiovascular medication in China. Results: The consistency and representativeness of existing clinical audits were still limited. SURF CHD (SUrvey of Risk Factors Coronary Heart Disease) was a straightforward and targeted clinical audit to simplify the recording and monitoring of routine CVD risk factors. SURF recruited 10,186 CHD patients in 11 countries among three different regions (Europe, Asia, and the Middle East). Recording and management of CVD risk factor was generally poor. Over 80% of participants had inadequate risk factor management with less than five risk factors being controlled. SURF found several characteristics had significant impacts on cardiovascular risk factor management. Women were less likely to achieve targets for total cholesterol (odds ratio <OR> 0.50, 95% confidence interval <CI> 0.43-0.59), low-density lipoprotein cholesterol (LDL) (OR 0.57, 95% CI 0.51-0.64), and glucose (OR 0.78, 95% CI 0.70-0.87), or to be physically active (OR 0.74, 95% CI 0.68-0.81) or non-obese (OR 0.82, 95% CI 0.74-0.90). Furthermore, to control three or more risk factor was less likely to be reached by women (OR 0.84. 95% CI 0.74-0.95), and those aged<55 years old (OR 0.62, 95% CI 0.52-0.74), and those with diabetes (OR 0.38, 95% CI 0.34-0.43). There were regional variations in determinants of risk factor management. For instance, attending cardiac rehabilitation was associated with better cardiovascular risk factor management in Europe. In contrast, such program was limited in Asia and the Middle East. It is feasible to link routinely measured CVD risk factor data with air pollution data to determine the feasibility of the methodology. But the interpretation is challenging given that this was a secondary prevention population and therefore already exposed to active risk factor management. Thirty-five studies were systematically reviewed to assess cardiovascular medication use in China. Current cardiovascular medication use is still inadequate, although a significant increase in beta-blocker and statin use was observed. The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, and nitrates was 92% (95% CI: 0.89±0.95), 63% (95% CI: 0.57±0.69), 72% (95% CI: 0.60±0.82), 49% (95% CI: 0.41±0.57), and 79% (95% CI: 0.74±0.91), respectively. A new phase of SURF CHD with improved methodology, an upgraded online data recruitment system, and better-structured recruitment strategy will be launched to provide regular and rapid cardiovascular risk factor information in more geographic areas. Conclusion: It is recommended that healthcare professionals take the findings into account to have a better understanding of cardiovascular risk factor recording and management in daily practice. A targeted, achievable, and relevant clinical audit, like SURF CHD, should be considered worldwide.