Prevalence of use and potential impact of increased use of primary care interventions to prevent cardiovascular hospitalizations in patients with diabetes.
OBJECTIVE
To estimate the reduction in hospitalizations due to cardiovascular complications of diabetes which could result from greater use of interventions of known effectiveness in a primary health care setting.


METHODS
In a representative survey of adults with diabetes in Porto Alegre, Brazil, we estimated current prevalence of interventions use (metformin, hypertension control, ACE inhibitors, statins, influenza vaccination, cardioprotective diet) and hospitalization rate. We calculated absolute risk reductions for interventions by applying relative risk reductions derived from literature to the baseline cardiovascular hospitalization rate. Increments in interventions use were obtained by subtracting current use prevalences from potential targets. We then modelled the number of diabetic patients needing primary health care coverage to prevent 1 hospitalization (disease impact number; DIN) and the total number of hospitalizations that might be prevented through this increased use.


RESULTS
In 5 years, for every 100 diabetic patients in the community, we ascertained 30 cardiovascular hospitalizations. Large gaps were observed between target and current use of interventions. With greater implementation, 48% of cardiovascular hospitalizations could possibly be prevented.


CONCLUSIONS
Major reduction in hospitalizations due to cardiovascular complications of diabetes could possibly be obtained through optimized use of effective treatments in primary health care settings such as this.
Luft
Vivian Cristine
VC
Graduate Studies Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, Brazil. vivi_luft@yahoo.com.br
Giugliani
Camila
C
Harzheim
Erno
E
Schmidt
Maria Inês
MI
Duncan
Bruce Bartholow
BB
D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011320:Primary Health Care / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior