Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.

Hdl Handle:
http://hdl.handle.net/10147/253510
Title:
Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.
Authors:
Zannad, Faiez; Dallongeville, Jean; Macfadyen, Robert J; Ruilope, Luis M; Wilhelmsen, Lars; De Backer, Guy; Graham, Ian; Lorenz, Matthias; Mancia, Giuseppe; Morrow, David A; Reiner, Zeljko; Koenig, Wolfgang
Affiliation:
Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre, France.
Citation:
Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy. 2011: Eur J Cardiovasc Prev Rehabil
Publisher:
European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology
Journal:
European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology
Issue Date:
3-Nov-2011
URI:
http://hdl.handle.net/10147/253510
DOI:
10.1177/1741826711424873
PubMed ID:
21947628
Abstract:
This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the 'treat-to-target' paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and 'real-world' populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.
Item Type:
Article
Language:
en
ISSN:
1741-8275

Full metadata record

DC FieldValue Language
dc.contributor.authorZannad, Faiezen_GB
dc.contributor.authorDallongeville, Jeanen_GB
dc.contributor.authorMacfadyen, Robert Jen_GB
dc.contributor.authorRuilope, Luis Men_GB
dc.contributor.authorWilhelmsen, Larsen_GB
dc.contributor.authorDe Backer, Guyen_GB
dc.contributor.authorGraham, Ianen_GB
dc.contributor.authorLorenz, Matthiasen_GB
dc.contributor.authorMancia, Giuseppeen_GB
dc.contributor.authorMorrow, David Aen_GB
dc.contributor.authorReiner, Zeljkoen_GB
dc.contributor.authorKoenig, Wolfgangen_GB
dc.date.accessioned2012-11-27T16:26:36Z-
dc.date.available2012-11-27T16:26:36Z-
dc.date.issued2011-11-03-
dc.identifier.citationPrevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy. 2011: Eur J Cardiovasc Prev Rehabilen_GB
dc.identifier.issn1741-8275-
dc.identifier.pmid21947628-
dc.identifier.doi10.1177/1741826711424873-
dc.identifier.urihttp://hdl.handle.net/10147/253510-
dc.description.abstractThis paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the 'treat-to-target' paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and 'real-world' populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherEuropean journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiologyen_GB
dc.rightsArchived with thanks to European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiologyen_GB
dc.titlePrevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.en_GB
dc.typeArticleen
dc.contributor.departmentInstitut Lorrain du Coeur et des Vaisseaux, Vandoeuvre, France.en_GB
dc.identifier.journalEuropean journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiologyen_GB
dc.description.provinceLeinsteren
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