Optimizing cardiovascular risk assessment and registration in a developing cardiovascular learning health care system: Women benefit most

T Katrien J Groenhof; Saskia Haitjema; A Titia Lely; Diederick E Grobbee; Folkert W Asselbergs; Michiel L Bots; UCC-CVRM and UPOD Study groups

doi:10.1371/journal.pdig.0000190

Optimizing cardiovascular risk assessment and registration in a developing cardiovascular learning health care system: Women benefit most

PLOS Digit Health. 2023 Feb 8;2(2):e0000190. doi: 10.1371/journal.pdig.0000190. eCollection 2023 Feb.

Authors

T Katrien J Groenhof¹, Saskia Haitjema², A Titia Lely³, Diederick E Grobbee¹, Folkert W Asselbergs^{4

5

6}, Michiel L Bots¹; UCC-CVRM and UPOD Study groups

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
² Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, The Netherlands.
³ Wilhelmina Children's Hospital Birth Centre, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, The Netherlands.
⁵ Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.
⁶ Health Data Research UK, Institute of Health Informatics, University College London, London, United Kingdom.

Abstract

Since 2015 we organized a uniform, structured collection of a fixed set of cardiovascular risk factors according the (inter)national guidelines on cardiovascular risk management. We evaluated the current state of a developing cardiovascular towards learning healthcare system-the Utrecht Cardiovascular Cohort Cardiovascular Risk Management (UCC-CVRM)-and its potential effect on guideline adherence in cardiovascular risk management. We conducted a before-after study comparing data from patients included in UCC-CVRM (2015-2018) and patients treated in our center before UCC-CVRM (2013-2015) who would have been eligible for UCC-CVRM using the Utrecht Patient Oriented Database (UPOD). Proportions of cardiovascular risk factor measurement before and after UCC-CVRM initiation were compared, as were proportions of patients that required (change of) blood pressure, lipid, or blood glucose lowering treatment. We estimated the likelihood to miss patients with hypertension, dyslipidemia, and elevated HbA1c before UCC-CVRM for the whole cohort and stratified for sex. In the present study, patients included up to October 2018 (n = 1904) were matched with 7195 UPOD patients with similar age, sex, department of referral and diagnose description. Completeness of risk factor measurement increased, ranging from 0% -77% before to 82%-94% after UCC-CVRM initiation. Before UCC-CVRM, we found more unmeasured risk factors in women compared to men. This sex-gap resolved in UCC-CVRM. The likelihood to miss hypertension, dyslipidemia, and elevated HbA1c was reduced by 67%, 75% and 90%, respectively, after UCC-CVRM initiation. A finding more pronounced in women compared to men. In conclusion, a systematic registration of the cardiovascular risk profile substantially improves guideline adherent assessment and decreases the risk of missing patients with elevated levels with an indication for treatment. The sex-gap disappeared after UCC-CVRM initiation. Thus, an LHS approach contributes to a more inclusive insight into quality of care and prevention of cardiovascular disease (progression).

Copyright: © 2023 Groenhof et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The UCC-CVRM is primarily financed by the UMC Utrecht as it is care as usual. UCC-CVRM as a whole, and via MLB as chair of the UCC-CVRM steering committee, was partly supported by a grant from the Netherlands Organization for Health Research and Development (#8480-34001) to develop feedback procedures, not for salary. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.