Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement

Abstract

Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary

“…Indeed, in the abovementioned 2016 Hungarian study, these rates were 47.8% and 45%, respectively, i.e. an improvement in the achievement of the target value for this parameter in Hungary (7). With regard to triglyceride target achievement, the treatment outcome of women shows a signi cantly more favourable picture compared to men in our study.…”

“…Hungarian study, HDL-C target attainment improved in both risk groups over the past 4-5 years from 66.7-82.2% in high risk and from 68-75.4% in very high risk (7).…”

Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary

“…In our study, HDL-C target attainment was > 80% in the high-risk group and > 75% in the very high-risk group, with significantly better treatment efficacy in men than in women. Compared with the results of a 2016 Hungarian study, HDL-C target attainment improved in both risk groups over the past 4–5 years from 66.7 to 82.2% in high-risk patients and from 68 to 75.4% in very high-risk patients [ 5 ].…”

“…The picture is less favourable for triglyceride targets, with just over 66% of high-risk individuals and 55% of very high-risk individuals achieving triglyceride levels below 1.7 mmol/l. In the 2016 Hungarian study, these rates were 47.8 and 45%, respectively; therefore, there was an improvement in the achievement of target values for this parameter in Hungary [ 5 ]. Regarding triglyceride target achievement, the treatment outcomes of women were significantly more favourable compared with men in our study.…”

“…Recognition, risk assessment, and treatment of cardiovascular risk factors to target levels play a crucial role in the prevention of cardiovascular diseases [ 4 ]. Data from previous Hungarian studies on smaller populations suggest that target level achievement is not adequate in cardiovascular prevention [ 5 , 6 ]. This is also a problem at the European level.…”