title: European Practice Assessment of Cardiovascular risk management (EPA Cardio): protocol of an international observational study in primary care.
abstract: BACKGROUND
  Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD) remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors.
  
  
  OBJECTIVE
  This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs.
  
  
  METHODS
  An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet) will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.
authors.affiliation: Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Germany. M.Wensing@iq.umcn.nl
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Sabine
authors.initials: S
authors.lastname: Ludt
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Eckhard
authors.initials: E
authors.lastname: Volbracht
authors.forename: Richard
authors.initials: R
authors.lastname: Grol