From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study

Abstract

Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Västerbotten, using Södermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255 000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400 000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.

Comparison of trends in cardiovascular risk factors between two regions with and without a community and primary care prevention programme

“…We do not know if this is due to better treatment of hypertensive subjects or to more beneficial changes in food or physical activity in in Va¨sterbotten 2001 to 2009 contributed. 17 It used lectures on treatment of hypertension, computerized decision support system with treatment recommendations and feedback of blood pressure control to the physician at the health care centre. A quick step up of medication up to three agents was advised but data from the Prescribed Drug Register shows a similar number of drugs prescribed among people with hypertension in both counties.…”

Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control

“…The SSPS has been described in detail elsewhere. 13 The study was approved by the ethics committee at Umeå University. Because the intervention was originally performed as a health care intervention and data for research purposes were collected retrospectively, no informed consent was obtained from individual participants, as approved by the ethics committee.…”

“…Blood pressure data were extracted from electronic health records using an automated script with greater than 95% sensitivity. 13 Mean SBP was calculated from all recorded values within 24 months after inclusion. Hypertension control was defined as a mean SBP lower than 140 mm Hg among individuals with previous hypertension diagnosis or an SBP of 140 mm Hg or higher at inclusion.…”

“…[10][11][12] The Swedish Stroke Prevention Study (SSPS) was developed as a health care intervention to overcome this inertia. 13 Through an electronic decision support system, lectures on antihypertensive treatment, and feedback on hypertension control, the SSPS aimed to improve the initiation and intensification of BP-lowering treatment by primary care physicians in Västerbotten County, Sweden. In this study, we assessed the association of the intervention with mean SBP levels and hypertension control rates by comparing data from Västerbotten County with data from Södermanland County as the control.…”

“…One factor in suboptimal hypertension control rates is clinical inertia among primary care physicians . The Swedish Stroke Prevention Study (SSPS) was developed as a health care intervention to overcome this inertia . Through an electronic decision support system, lectures on antihypertensive treatment, and feedback on hypertension control, the SSPS aimed to improve the initiation and intensification of BP-lowering treatment by primary care physicians in Västerbotten County, Sweden.…”