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A Multicentre, Randomised Controlled Trial of a Structured Care Algorithm to Achieve Individual Blood Pressure Targets at 26 weeks in Primary Care: The VIPER-BP Study
S4
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Allied Health Affiliate Finalists
8
7
Community Screening Programs to Identify Unknown Atrial Fibrillation: A Systematic Review
A Multicentre, Randomised Controlled Trial of a Structured Care Algorithm to Achieve Individual Blood Pressure Targets at 26 weeks in Primary Care: The VIPERBP Study Carrington 1,∗ ,
G. M. Kurstjens 2 , S. Stewart 1 1 Baker
Jennings 1 ,
C.
Swemmer 2 ,
N.
IDI Heart and Diabetes Institute, Australia Pharmaceuticals Pty Ltd, Australia
2 Novartis
Background: The Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP Study) examined the impact of a structured care algorithm to optimise risk profiling and BP control in a hypertensive, primary care cohort. Methods: RCT involving 119 primary care clinics Australia-wide. Overall, 1562 patients (59 ± 12 years, 62% men, 67% prior hypertension and BP 150 ± 17/88 ± 11 mmHg) who remained above their individualised BP target were randomised (1:2 ratio) to usual care (UC, n = 524) or the VIPER-BP intervention (n = 1038). The primary endpoint was individualised BP control at 26 weeks. Results: Individualised BP targets were the same in both groups (≤125/75 [17%], 130/80 [54%] and 140/90 mmHg [29%]). Reductions in systolic and diastolic BP favoured the VIPER-BP intervention (p < 0.0001): 14.6 (95% CI −13.7 to −15.6)/−8.2 (95% CI −7.6 to −8.8) mmHg versus 10.4 (95% CI −11.7 to −9.1)/5.6 (95% CI −4.7 to −6.4) mmHg. More VIPER-BP patients reached their individual BP target (37% vs. 29%; adjusted RR 1.31, 95% CI 1.11–1.54, p = 0.001) and a BP ≤ 140/90 mmHg (61% vs. 52%; adjusted RR 1.18, 95% CI 1.07–1.31, p = 0.001). On an adjusted basis, patients managed by a GP clinic with a practice nurse were more likely to achieve individual BP control (41% vs. 27%; RR 1.50, 95% CI 1.30–1.73, p = 0.004). Conclusions: VIPER-BP shows a structured BP management approach results in significantly better BP control in primary care; particularly when facilitated by a practice nurse. http://dx.doi.org/10.1016/j.hlc.2012.05.017
N. Lowres 1,2,3,∗ , L. Freedman 1,2,3
Neubeck 4 , J.
Redfern 3,4 , S.
1 Anzac
Research Institution, University of Sydney, Sydney, Australia 2 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia 3 Sydney Medical School, University of Sydney, Sydney, Australia 4 The George Institute for Global Health, Sydney, Australia Background: The prevalence of atrial fibrillation (AF) is escalating. AF is associated with a five to seven-fold increased stroke risk which is highly preventable with appropriate oral anticoagulant therapy (OAC). Unfortunately, AF may be asymptomatic and unrecognised prior to stroke. We aimed to determine if community-based screening for AF could effectively identify previously undiagnosed AF, for stroke prevention. Methods: Systematic review of clinical trials by searching electronic medical databases, reference lists and grey literature. Trials were included if they evaluated a general ambulant population, using an intervention designed to identify AF. Results: We identified 17 individual screening programs to identify AF (n = 41,511, mean age 69 ± 6 years, 45% male) in six countries. Participants were recruited either from general practitioner (GP) practices, outpatient clinics or community advertisements. Screening methods for AF varied between trials and included 12- or single-lead ECG, and pulse palpation. Prevalence of AF was 3.32% (95% CI, 3.15–3.5%). Overall incidence of previously unknown AF (10 trials, n = 25,466) was 1.43% (CI, 1.28–1.58%). Community advertised programs (4 trials, n = 13,379) identified a similar incidence (1.49%, CI, 1.29–1.71%) to screening in GP/outpatient clinics (6 trials, n = 12,087) incidence 1.36% (CI, 1.16–1.58%) (p = 0.3). Additionally, a significant treatment gap was identified: of 61% eligible for OAC only 31% were treated with OAC (6 trials, n = 16,861) (p > 0.001). Conclusions: Community screening identified 1.4% with previously undiagnosed AF. Many of those identified would be eligible for, and benefit from OAC to prevent stroke. Given this incidence, community AF screening strategies could potentially reduce the overall health burden associated with AF. http://dx.doi.org/10.1016/j.hlc.2012.05.018
Heart, Lung and Circulation 2012;21:S1–S142
CSANZ 2012 Abstracts
ABSTRACTS
Allied Health Affiliate Finalists
8
7
Community Screening Programs to Identify Unknown Atrial Fibrillation: A Systematic Review
A Multicentre, Randomised Controlled Trial of a Structured Care Algorithm to Achieve Individual Blood Pressure Targets at 26 weeks in Primary Care: The VIPERBP Study Carrington 1,∗ ,
G. M. Kurstjens 2 , S. Stewart 1 1 Baker
Jennings 1 ,
C.
Swemmer 2 ,
N.
IDI Heart and Diabetes Institute, Australia Pharmaceuticals Pty Ltd, Australia
2 Novartis
Background: The Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP Study) examined the impact of a structured care algorithm to optimise risk profiling and BP control in a hypertensive, primary care cohort. Methods: RCT involving 119 primary care clinics Australia-wide. Overall, 1562 patients (59 ± 12 years, 62% men, 67% prior hypertension and BP 150 ± 17/88 ± 11 mmHg) who remained above their individualised BP target were randomised (1:2 ratio) to usual care (UC, n = 524) or the VIPER-BP intervention (n = 1038). The primary endpoint was individualised BP control at 26 weeks. Results: Individualised BP targets were the same in both groups (≤125/75 [17%], 130/80 [54%] and 140/90 mmHg [29%]). Reductions in systolic and diastolic BP favoured the VIPER-BP intervention (p < 0.0001): 14.6 (95% CI −13.7 to −15.6)/−8.2 (95% CI −7.6 to −8.8) mmHg versus 10.4 (95% CI −11.7 to −9.1)/5.6 (95% CI −4.7 to −6.4) mmHg. More VIPER-BP patients reached their individual BP target (37% vs. 29%; adjusted RR 1.31, 95% CI 1.11–1.54, p = 0.001) and a BP ≤ 140/90 mmHg (61% vs. 52%; adjusted RR 1.18, 95% CI 1.07–1.31, p = 0.001). On an adjusted basis, patients managed by a GP clinic with a practice nurse were more likely to achieve individual BP control (41% vs. 27%; RR 1.50, 95% CI 1.30–1.73, p = 0.004). Conclusions: VIPER-BP shows a structured BP management approach results in significantly better BP control in primary care; particularly when facilitated by a practice nurse. http://dx.doi.org/10.1016/j.hlc.2012.05.017
N. Lowres 1,2,3,∗ , L. Freedman 1,2,3
Neubeck 4 , J.
Redfern 3,4 , S.
1 Anzac
Research Institution, University of Sydney, Sydney, Australia 2 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia 3 Sydney Medical School, University of Sydney, Sydney, Australia 4 The George Institute for Global Health, Sydney, Australia Background: The prevalence of atrial fibrillation (AF) is escalating. AF is associated with a five to seven-fold increased stroke risk which is highly preventable with appropriate oral anticoagulant therapy (OAC). Unfortunately, AF may be asymptomatic and unrecognised prior to stroke. We aimed to determine if community-based screening for AF could effectively identify previously undiagnosed AF, for stroke prevention. Methods: Systematic review of clinical trials by searching electronic medical databases, reference lists and grey literature. Trials were included if they evaluated a general ambulant population, using an intervention designed to identify AF. Results: We identified 17 individual screening programs to identify AF (n = 41,511, mean age 69 ± 6 years, 45% male) in six countries. Participants were recruited either from general practitioner (GP) practices, outpatient clinics or community advertisements. Screening methods for AF varied between trials and included 12- or single-lead ECG, and pulse palpation. Prevalence of AF was 3.32% (95% CI, 3.15–3.5%). Overall incidence of previously unknown AF (10 trials, n = 25,466) was 1.43% (CI, 1.28–1.58%). Community advertised programs (4 trials, n = 13,379) identified a similar incidence (1.49%, CI, 1.29–1.71%) to screening in GP/outpatient clinics (6 trials, n = 12,087) incidence 1.36% (CI, 1.16–1.58%) (p = 0.3). Additionally, a significant treatment gap was identified: of 61% eligible for OAC only 31% were treated with OAC (6 trials, n = 16,861) (p > 0.001). Conclusions: Community screening identified 1.4% with previously undiagnosed AF. Many of those identified would be eligible for, and benefit from OAC to prevent stroke. Given this incidence, community AF screening strategies could potentially reduce the overall health burden associated with AF. http://dx.doi.org/10.1016/j.hlc.2012.05.018