Netherlands Heart Foundation
Vascular risk management: I + I makes more than 2 Dealng with risk factors: ther s stil so much to be gained It is estimated that at this moment in the Netherlands more than 800,000 people live with the consequences of cardiovascular disease. Cardiovascular disease remains the leading cause of death and disability. Each year around 88,000 people suffer from peripheral arterial diseases, a heart attack, or a stroke. Studies such as the NHF care programme'/EuroAspire have revealed that among heart patients more than 30% smoke, more than 70% are overweight, 50% are hypertensive, 43% have a raised cholesterol level, and 58% do not exercise enough2. A similar alarming pattern is seen among patients suffering from peripheral arterial diseases or ischaemic strokes.3 An effective approach to dealing with the risk factors can curb atherosderosis, which can strongly reduce the associated morbidity and mortality. In addition, this also leads to an improved quality oflife and the chance ofa longer lif expectancy. What Is vascular risk management (VRM)? The draft guidelines for cardiovascular risk management employ the following definition: 'cardiovascular risk management is the diagnosis and treatment of risk factors for cardiovascular disease in persons with an increased risk ofinitial or new manifestations of cardiovascular disease caused by atherothrombotic processes'.4 The Vascular Risk Management Programme The Netherlands Heart Foundation initiated the Vascular Risk Management Programme. The aim of the programme is to ensure that vascular risk management is integrated in the treatment of patients with cardiac disease, stroke, peripheral arterial disease and high-risk patients. This programme emphasizes stimulation of an integrated approach to dealing with risk factors. The focus on an integrated approach does justice to the patient and to the facts regarding risk factor treatment: 1 + 1 makes more than 2. The programme is based on the results of the NHF care programme, a systematic literature review,2 an inventory of initiatives taken in Dutch hospitals in the field ofvascular risk management, and an expert meeting. In addition to the high prevalence ofrisk factors among patients with cardiovascular disease, the NHF care programme showed that the medical treatment of heart patients has improved since 1995. It seems evident, however, that further improvement is possible in education about lifestyle, changes in behaviour and use of drugs. From the systematic literature review effects can be seen in the improvement of the cardiovascular risk profile through interventions associated with a careful screening for risk factors, counselling and individually tailored information for the patient, and a follow-up of at least one year. Larger studies and meta-analyses are required, however, to explore the effect on the cardiovascular risk profile, morbidity and mortality. 290
The NHBF inventory of consultations and outpatient clinics for vascular risk management revealed that there are 90 possibilities for consultations in the 128 hospitals located in the Netherlands. Forty hospitals are planning to start a consultation option. Only 24 initiatives cover all groups of patients: those with peripheral arterial disease, coronary patients, cerebrovascular patients and high-risk groups. It is striking that the collaboration with the family doctor is very limited. An enormous diversity is evident in what is done during consultations with regard to the diagnosis, treatment and monitoring of risk factors. This casts doubt on whether there is an integral approach because not all risk factors receive the same amount of attention. It is also evident that there are many impediments to establishing such initiatives. This inventory will be continued: the consultations addressing all groups of patients will be analysed in detail. The expert meeting held on March 24 2005 came to the following conclusion. One sole multidisciplinary guideline is essential, which pays attention to lifestyle factors, and is then carried out by professionals. Training for professionals is needed, concentrating on risk communication and changes in lifestyle. Self-management by patients must be stimulated. Changes in the organisation of care are required, involving task delegation, ICT support and new, easily accessible structures (such as health centres). A financial structure for vascular risk management is needed. Given the quantity and diversity of the problems and proposed recommendations, no one group can improve vascular risk management in the Netherlands by itself. A joint approach is essential to optimally utilise existing knowledge, experience and initiatives. The NHF is taking the initiative to bring the different parties together. The NHF hopes to stimulate this communal approach strongly, because it is also true here that: 1 + 1 makes more than 2! For more information: www.harstichting.nl/zorgverleners, page 'Vaatziekten'. E Anne-Margreet Strijbis, Marianne van Oosterhout, Programme managersfor patient care Netherlands Heart Foundation 1
2 3 4
The NHF care programme explores the extent to which existing guidelines are applied in the treatment ofcardiovascular patients. The NHF care programme is the Dutch contribution to the Euro Heart Survey, an initiative of the European Society of Cardiology. For more information: www.hartstichting.nl/research: Cavaris. Lifestyle and risk factor management and use ofdrug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. European Heart Journal 2001;22:554-72. Koppelaar C, Scholte Op ReimerW, Effectiveness of conservative treatment of cardiovascular risk factors among patients with a cardiovascular disease. The Hague: Netherlands Heart Foundation. February 2005. Draft Multidisciplinary Guidelines for Cardiovascular Risk Management. Utrecht: CBO/NHG. June 2005.
Ne&hand Heart journal Volume 13, Number 7/8, August 2005
Vascular risk management: I + I makes more than 2 Dealng with risk factors: ther s stil so much to be gained It is estimated that at this moment in the Netherlands more than 800,000 people live with the consequences of cardiovascular disease. Cardiovascular disease remains the leading cause of death and disability. Each year around 88,000 people suffer from peripheral arterial diseases, a heart attack, or a stroke. Studies such as the NHF care programme'/EuroAspire have revealed that among heart patients more than 30% smoke, more than 70% are overweight, 50% are hypertensive, 43% have a raised cholesterol level, and 58% do not exercise enough2. A similar alarming pattern is seen among patients suffering from peripheral arterial diseases or ischaemic strokes.3 An effective approach to dealing with the risk factors can curb atherosderosis, which can strongly reduce the associated morbidity and mortality. In addition, this also leads to an improved quality oflife and the chance ofa longer lif expectancy. What Is vascular risk management (VRM)? The draft guidelines for cardiovascular risk management employ the following definition: 'cardiovascular risk management is the diagnosis and treatment of risk factors for cardiovascular disease in persons with an increased risk ofinitial or new manifestations of cardiovascular disease caused by atherothrombotic processes'.4 The Vascular Risk Management Programme The Netherlands Heart Foundation initiated the Vascular Risk Management Programme. The aim of the programme is to ensure that vascular risk management is integrated in the treatment of patients with cardiac disease, stroke, peripheral arterial disease and high-risk patients. This programme emphasizes stimulation of an integrated approach to dealing with risk factors. The focus on an integrated approach does justice to the patient and to the facts regarding risk factor treatment: 1 + 1 makes more than 2. The programme is based on the results of the NHF care programme, a systematic literature review,2 an inventory of initiatives taken in Dutch hospitals in the field ofvascular risk management, and an expert meeting. In addition to the high prevalence ofrisk factors among patients with cardiovascular disease, the NHF care programme showed that the medical treatment of heart patients has improved since 1995. It seems evident, however, that further improvement is possible in education about lifestyle, changes in behaviour and use of drugs. From the systematic literature review effects can be seen in the improvement of the cardiovascular risk profile through interventions associated with a careful screening for risk factors, counselling and individually tailored information for the patient, and a follow-up of at least one year. Larger studies and meta-analyses are required, however, to explore the effect on the cardiovascular risk profile, morbidity and mortality. 290
The NHBF inventory of consultations and outpatient clinics for vascular risk management revealed that there are 90 possibilities for consultations in the 128 hospitals located in the Netherlands. Forty hospitals are planning to start a consultation option. Only 24 initiatives cover all groups of patients: those with peripheral arterial disease, coronary patients, cerebrovascular patients and high-risk groups. It is striking that the collaboration with the family doctor is very limited. An enormous diversity is evident in what is done during consultations with regard to the diagnosis, treatment and monitoring of risk factors. This casts doubt on whether there is an integral approach because not all risk factors receive the same amount of attention. It is also evident that there are many impediments to establishing such initiatives. This inventory will be continued: the consultations addressing all groups of patients will be analysed in detail. The expert meeting held on March 24 2005 came to the following conclusion. One sole multidisciplinary guideline is essential, which pays attention to lifestyle factors, and is then carried out by professionals. Training for professionals is needed, concentrating on risk communication and changes in lifestyle. Self-management by patients must be stimulated. Changes in the organisation of care are required, involving task delegation, ICT support and new, easily accessible structures (such as health centres). A financial structure for vascular risk management is needed. Given the quantity and diversity of the problems and proposed recommendations, no one group can improve vascular risk management in the Netherlands by itself. A joint approach is essential to optimally utilise existing knowledge, experience and initiatives. The NHF is taking the initiative to bring the different parties together. The NHF hopes to stimulate this communal approach strongly, because it is also true here that: 1 + 1 makes more than 2! For more information: www.harstichting.nl/zorgverleners, page 'Vaatziekten'. E Anne-Margreet Strijbis, Marianne van Oosterhout, Programme managersfor patient care Netherlands Heart Foundation 1
2 3 4
The NHF care programme explores the extent to which existing guidelines are applied in the treatment ofcardiovascular patients. The NHF care programme is the Dutch contribution to the Euro Heart Survey, an initiative of the European Society of Cardiology. For more information: www.hartstichting.nl/research: Cavaris. Lifestyle and risk factor management and use ofdrug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. European Heart Journal 2001;22:554-72. Koppelaar C, Scholte Op ReimerW, Effectiveness of conservative treatment of cardiovascular risk factors among patients with a cardiovascular disease. The Hague: Netherlands Heart Foundation. February 2005. Draft Multidisciplinary Guidelines for Cardiovascular Risk Management. Utrecht: CBO/NHG. June 2005.
Ne&hand Heart journal Volume 13, Number 7/8, August 2005
