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. 2023 May 8;36(3):462-476.
doi: 10.3122/jabfm.2022.220331R1. Epub 2023 May 11.

Estimating the Cardiovascular Disease Risk Reduction of a Quality Improvement Initiative in Primary Care: Findings from EvidenceNOW

Stephan R Lindner  1 , Bijal Balasubramanian  2 , Miguel Marino  2 , K John McConnell  2 , Thomas E Kottke  2 , Samuel T Edwards  2 , Sam Cykert  2 , Deborah J Cohen  2
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Estimating the Cardiovascular Disease Risk Reduction of a Quality Improvement Initiative in Primary Care: Findings from EvidenceNOW

Stephan R Lindner et al. J Am Board Fam Med. .

Abstract

Background: This study estimates reductions in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, a multi-state initiative that sought to improve cardiovascular preventive care in the form of (A)spirin prescribing for high-risk patients, (B)lood pressure control for people with hypertension, (C)holesterol management, and (S)moking screening and cessation counseling (ABCS) among small primary care practices by providing supportive interventions such as practice facilitation.

Design: We conducted an analytic modeling study that combined (1) data from 1,278 EvidenceNOW practices collected 2015 to 2017; (2) patient-level information of individuals ages 40 to 79 years who participated in the 2015 to 2016 National Health and Nutrition Examination Survey (n = 1,295); and (3) 10-year ASCVD risk prediction equations.

Measures: The primary outcome measure was 10-year ASCVD risk.

Results: EvidenceNOW practices cared for an estimated 4 million patients ages 40 to 79 who might benefit from ABCS interventions. The average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% (absolute risk reduction: -0.08, P ≤ .001). This risk reduction would prevent 3,169 ASCVD events over 10 years and avoid $150 million in 90-day direct medical costs.

Conclusion: Small preventive care improvements and associated reductions in absolute ASCVD risk levels can lead to meaningful life-saving benefits at the population level.

Keywords: Cardiology; Cardiovascular Diseases; Nutrition Surveys; Preventive Health Care; Primary Health Care; Quality Improvement.

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Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest to declare.

Figures

Appendix Figure A-l:
Appendix Figure A-l:
Estimated 10-year ASCVD risk based on NHANES versus patient characteristics from North Carolina
Appendix Figure A-2:
Appendix Figure A-2:
Estimated 10-yeax ASCVD risk based on NHANES versus patient characteristics from New York
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References

    1. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC, Sorlie P, Stone NJ, Wilson PWF. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2013;129(25 suppl 2):S49–S73. Available from: 10.1161/01.cir.0000437741.48606.98. - DOI - PubMed
    1. Lloyd-Jones DM, Huffman MD, Karmali KN, Sanghavi DM, Wright JS, Pelser C, Gulati M, Masoudi FA, Goff DC. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients. Journal of the American College of Cardiology. 2017;69(12):1617–1636, Available from: 10.1016/j.jacc.2016.10.018. - DOI - PMC - PubMed
    1. Byrd RH, Lu P, Nocedal J, Zhu C. A Limited Memory Algorithm for Bound Constrained Optimization. SIAM Journal on Scientific Computing. 1995;16(5):1190–1208. Available from: 10.1137/0916069. - DOI
    1. Benjamin EJ, Muntner P, Alonso A, On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation 2019;139:e56–e528. - PubMed
    1. Lloyd-Jones DM, Huffman MD, Karmali KN, et al. Estimating longitudinal risks and benefits from cardiovascular preventive therapies among Medicare patients. Journal of the American College of Cardiology 2017;69:1617–36. - PMC - PubMed