Decrease in Cardiovascular Disease Risk Due to a National Initiative to Improve Preventive Services in Small Primary Care Practices
Abstract
Research Objective
Cardiovascular disease (CVD) such as heart failure and stroke has been the top cause of death for over 90 years. The beneficial effects of four simple treatment options -- aspirin prescription, blood pressure control, cholesterol management and smoking screening and cessation counseling (ABCS) -- in reducing mortality are well established. Yet, delivering the ABCS at optimal levels continues to be challenging for primary care practices, where the majority of patients receive care. In 2015, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in Primary Care, a national, 110 million dollar initiative focused on providing external support interventions (e.g., practice facilitation or health information technology support) to 1500 small-to-medium sized primary care practices with over eight million patients. The research objective of this study was to estimate EvidenceNOW-related reductions in the risk of experiencing an adverse CVD event.
Study Design
Study Design: We developed a new methodology to calculate CVD risk using (i) ABCS levels of EvidenceNOW practices; (ii) patient-level information from the National Health and Nutrition Examination Survey (NHANES); and (iii) information about CVD risk over a 10-year period developed by the American College of Cardiology and the American Heart Association. We estimated 10-year CVD risk at baseline, just before EvidenceNOW started, and reductions to risk due to EvidenceNOW-related improvements in the ABCS.
Population Studied
Primary care practices participating in EvidenceNOW and NHANES study participants.
Principal Findings
The average 10-year CVD risk at baseline was estimated to be 10.3 percent among patients of practices participating in the initiative. Improvements in the ABCS due to EvidenceNow reduced this risk by about 0.1 percentage points, or approximately 1.0 percent relative to baseline. Two patient populations had the biggest CVD risk reduction: those with hypertension and those with multiple comorbidities who have a high CVD risk. According to these estimates, EvidenceNOW prevented about 4000 CVD events at a cost of approximately $29,000 per event.
Conclusions
EvidenceNOW successfully reduced CVD events among patients of practices participating in the initiative, although overall reductions were small. Risk reductions were stronger for high-risk patients, such as those with multiple comorbidities.
Implications for Policy or Practice
Preventive care efforts to reduce cardiovascular disease in primary care practices are cost effective even for a large patient population with moderate CVD risk and therefore should be implemented more widely. Targeting specific patient population can be a valuable policy to improve the health of high-risk populations.
Primary Funding Source
Agency for Healthcare Research and Quality.
