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The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century
OBJECTIVE: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year f...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Taylor & Francis
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293959/ https://www.ncbi.nlm.nih.gov/pubmed/34092186 http://dx.doi.org/10.1080/02813432.2021.1913893 |
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author | Kuneinen, Susanna M. Eriksson, Johan G. Kautiainen, Hannu Ekblad, Mikael O. Korhonen, Päivi E. |
author_facet | Kuneinen, Susanna M. Eriksson, Johan G. Kautiainen, Hannu Ekblad, Mikael O. Korhonen, Päivi E. |
author_sort | Kuneinen, Susanna M. |
collection | PubMed |
description | OBJECTIVE: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN: A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner’s (GP) appointment for high-risk persons. Screening and interventions were performed during 2005–2006. SETTING: A public health care centre in the town of Harjavalta, Finland. SUBJECTS: All home-dwelling 45–70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES: All-cause and CVD mortality. RESULTS: Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants’. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS: Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis. KEY POINTS: Previously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community. Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons. Subjects not willing to participate in health surveys have the worst prognosis. |
format | Online Article Text |
id | pubmed-8293959 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
spelling | pubmed-82939592021-08-03 The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century Kuneinen, Susanna M. Eriksson, Johan G. Kautiainen, Hannu Ekblad, Mikael O. Korhonen, Päivi E. Scand J Prim Health Care Original Articles OBJECTIVE: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN: A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner’s (GP) appointment for high-risk persons. Screening and interventions were performed during 2005–2006. SETTING: A public health care centre in the town of Harjavalta, Finland. SUBJECTS: All home-dwelling 45–70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES: All-cause and CVD mortality. RESULTS: Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants’. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS: Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis. KEY POINTS: Previously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community. Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons. Subjects not willing to participate in health surveys have the worst prognosis. Taylor & Francis 2021-06-07 /pmc/articles/PMC8293959/ /pubmed/34092186 http://dx.doi.org/10.1080/02813432.2021.1913893 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Kuneinen, Susanna M. Eriksson, Johan G. Kautiainen, Hannu Ekblad, Mikael O. Korhonen, Päivi E. The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title | The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title_full | The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title_fullStr | The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title_full_unstemmed | The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title_short | The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
title_sort | feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293959/ https://www.ncbi.nlm.nih.gov/pubmed/34092186 http://dx.doi.org/10.1080/02813432.2021.1913893 |
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