Onderzoek naar het effect op de SCORE-score en cardiovasculaire risicofactoren van een jaar intensieve behandeling in de huisartsenpraktijk door praktijkondersteuners ten opzichte van de NHG-standaard

Research after the effect on SCORE-score and cardiovascular risk factors of a year intensive follow-up treatment in general practice by nurse practitioners compared to the current NHG-standard. Introduction: Cardiovascular disease constitutes a large portion of the mortality in the Netherlands. There is a great knowledge base of recognized risk factors that contribute to the development of cardiovascular disease. The SCORE-risk function can calculate the 10-year cardiovascular mortality risk based on those risk factors. With the current rise and increasing ease of use of in-home self-measurement equipment and the expanding role of nurse practitioners in general practice there are new options emerging for cardiovascular risk management. Patients with increased cardiovascular risk can keep track of risk factors at home and communicate these with nurse practitioners. This has the potential to increase involvement of patients in their treatment and stimulate in their self-management. In this research the effect on the SCORE-score of intensive treatment by nurse practitioners aided by in-home self-measurement equipment is compared to the treatment according to the current NHG-standard. Other recognized cardiovascular risk factors are also measured and compared. Methods: The study design is a randomized controlled trial. 218 participants with a SCORE-score of 5% and above from 20 general practices in the north of the Netherlands have been randomized into two treatment arms. The control group received a year of cardiovascular risk management according to the current NHG-standard, executed by nurse practitioners. In the intervention group this regiment was expanded by intensive multiple contacts with nursepractitioners, with regular opportunities for exchange of data measures by in-home self-measurement equipment. The follow-up course lasted for a year and has been completed by 175 participants. At baseline and at the end cardiovascular risk has been measured and the SCORE-score calculated. All data was analyzed statistically in SPSS. Results: Both the control and intervention group experienced a drop in SCORE-score and all other measured cardiovascular risk factors except for BMI and blood glucose. There was no significant difference in change between both treatment arms. Within the intervention group there turned out to be a significantly larger number of new prescriptions for antihypertensive drugs, without actually adding to a decrease in cardiovascular risk compared to the control group. More women than men ceased their smoking habits. Women also experience a greated drop in blood pressure than men. Discussion and conclusion: Cardiovascular risk management according the NHG-standard results in a decrease of cardiovascular risk. A more intensive treatment with adjuvant use of in-home self-measurement equipment has no added effect to this. Intensifying treatment seems to lead to extra prescriptions without practical effect. It is recommended for future research to measure the motivation and other personality descriptors of participants. Such trials have the potential to develop a cardiovascular risk treatment that is fitted for the needs of the individual patient.