Recommendations on Primary Prevention of Cardiovascular Disease in General Practice – a Systematic Guideline Review

Lara Schürmann, Maren Bredehorst, Dennis Firmansyah, Christiane Muth, Ana Isabel González-González, Veronika Van Der Wardt, Jörg Haasenritter, Svetlana Puzhko

Keywords: cardiovascular disease, primary care, primary prevention, general practice

Background:

Cardiovascular disease (CVD) is the leading cause of death in Europe. Therefore, CVD prevention counseling is an important issue in general practice.

Research questions:

What are the current recommendations of national (German) and international guidelines for primary prevention of CVD in adults in general practice?

Method:

We conducted a systematic guideline review using the methodology of Muth et al. We searched medical databases and websites of guideline-producing societies from 2016 onwards for the guidelines on the primary prevention of CVD in adults. We assessed the quality of the guidelines using the MiChe tool, extracted relevant recommendations, cross-analyzed them for consistency, and assessed the quality of the supporting literature (e.g. ROBIS in case of a systematic review).

Results:

We identified 26 guidelines, 19 of which were of very good quality. We extracted 581 recommendations on risk assessment, pharmacological and non-pharmacological interventions, and patient-provider communication. Most guidelines recommended risk assessment for patients >40 years of age using standardized tools. Recommendations for pharmacological and non-pharmacological prevention consistently advised personalizing prevention strategies based on patients’ health characteristics and their goals and preferences. The respective examples include treating patients with high CVD risk with atorvastatin 20 mg/day and advising patients with elevated blood pressure to reduce salt intake. All included guidelines recommend shared decision-making for pharmacological prevention and lifestyle changes after a patient has been informed about their individual CVD risk. Recommendations on many important aspects of CVD prevention (drug dosages, risk assessment scores) were inconsistent and conflicting.

Conclusions:

Even though current recommendations for some components of primary CVD prevention are consistent across international guidelines, most recommendations are inconsistent, possibly due in part to the influence of different health care contexts. Further research on primary prevention of CVD is recommended to inform high-quality, evidence-based guidelines.

Points for discussion:

How can a patient-centered approach in CVD prevention, including shared decision-making and consideration of individual patient needs and preferences, be implemented throughout GP practices?

What could be possible reasons for the inconsistencies and conflicting recommendations found in the guidelines?

How can these discrepancies impact CVD prevention in general practice?

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