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AN ASSESSMENT OF THE PRIMARY PREVENTION CONTROL PROGRAM OF PHC PREVENTIVE CARDIOLOGY CLINIC AMONG PATIENTS AT RISK FOR CVD: A Retrospective Cohort Study. Preventive Cardiology Division, Philippine Heart Center. INTRODUCTION. - PowerPoint PPT Presentation
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AN ASSESSMENT OF THE PRIMARY PREVENTION CONTROL PROGRAM OF PHC PREVENTIVE
CARDIOLOGY CLINIC AMONG PATIENTS AT RISK FOR CVD: A Retrospective Cohort Study
Preventive Cardiology Division,
Philippine Heart Center
INTRODUCTION
• According to Global Burden of Disease Study estimate, CVD accounted for 10% of global disease burden, with a projected rise to almost 15% by 2020.
• Cardiovascular disease is the single most common cause of death in the world.
• Risk factor management should be thought of as prevention or treatment of the atherosclerotic disease process itself and, as such, should be included as an integral part of any management plan for the many acute or chronic manifestations of this disease.
PREVALENCE OF RISK FACTORS
11.8
25.3 26.624.9
4.68.5
34.8
17.4
34.8
4.8
0
5
10
15
20
25
30
35
40
%
Dans A. et al National Nutrition and Health Survey (NNHeS): Atherosclerosis-related Diseases and Risk Factors. 2003 and 2008
OBEJCTIVES
• General Objective:– Evaluate effectiveness of the primary prevention
control program for CVD of the Preventive Cardiology Division of the Philippine Heart Center.
• Specific Objectives:– Determine the mean change of the SBP, DBP, FBS
and lipid profile from baseline and on follow-up.– Determine the percentage of patients who eventually
developed CVD.
METHODOLOGY• Trial Design
– Retrospective cohort trial. • Inclusion Citeria
– Adults > 21 years old– Any one of the major risk factors.– Any one of the predisposing risk
factors but with at least 1 major risk factor.
– Patients with a minimum follow-up period of 3 consecutive years and at least 2 follow-ups per year will be included in the efficacy analysis of the study.
• Exclusion Criteria– Patients are considered ineligible
to participate if they have an existing atherosclerotic cardiovascular disease (e.g. CAD, CVA, etc.)
MAJOR RISK FACTORS
•Hypertension
•Diabetes mellitus
•Dyslipidemia
PREDISPOSING RISK FACTORS
• Obesity
• Physical inactivity
• Family history of premature CHD
INTERVENTION
• Health Education• Nutrition Counseling• Exercise Prescription• Guideline for the management of
individual risk factors provided by the following:– NCEP-ATP III– JNC VII– ADA’s Standards of Diabetes Care
RESULTS
• From February 2002 to December 2009, there were a total of 1008 patients who are actively following up at our clinic.
• Out of the 1008 patients being seen at our clinic, 148 patients, satisfied the inclusion criteria for assessment of efficacy of treatment intervention.
RESULTS
Male
Female
< 40
41-60
61-80
> 80
N = 1008 patients
Sex:
Age:
0
10
20
30
40
50
60
70
80
Hypertensive
Diabetes Mellitus
Dyslipidemia
Obese
Present Smoker
RESULTS
Male
Female
< 40
41-60
61 - 80
> 800
10
20
30
40
50
60
70
80
90
100
Hypertensive
Diabetes Mellitus
Dyslipidemia
Obese
Present Smoker
N = 148 patients
BP on follow-up
0
20
40
60
80
100
120
140
160
SBP mmHg
DBP mmHg
BP reduction from baseline of 11/20 mmHg (p< 0.05)
FBS on follow-up
0
20
4060
80
100
120140
160
180
Baseline 6 mos 24 mos 48 mos 72 mos
FBS mg/dL
FBS mean reduction of 51 mg/dL from baseline (p = 0.79).
Lipid Profile on follow-up
0
50
100
150
200
250
Baseline 12 mos 48 mos 84 mos
Total Chol
Triglycerides
HDL
LDL
TC mean reduction = 24mg/dl (p=0.49); TG mean reduction = 55mg/dl (p=0.002); HDL mean reduction = 1mg/dl (p=ns); LDL mean reduction = 11mg/dl (p=ns)
RESULTS
• During the seven years follow-up:– six patients (4 males and 2 females) died due
to cardiovascular disease – three (2 males and 1 female) died from other
causes
• One female patient had myocardial infarction.
• Two males had cerebrovascular accident.
Conclusions
• The results of our intervention on our patients enrolled in the Primary Prevention Clinic showed a reduction in the CV risk factors.
• Though the BP reduction was significant, the target blood pressure set by the guidelines was not achieved.
• There were reductions in the FBS, TC and LDL-C but was not statistically significant.
• There was a significant decrease in TG and a non-significant small decrease in HDL-C.
Recommendations
• Strengthening of the health education programs, including the nutrition counseling, should be done.
• Exercise programs that will address the concern on obesity should be strengthened.
• Intervention programs to help stop smoking should also be initiated.
An ounce of
prevention is
better than a
pound of cure.
Thank you!