title: Feasibility and outcomes of screening for cardiovascular risk factors in the emergency department.
abstract: OBJECTIVE
  The present study aimed to determine the prevalence of undiagnosed and undertreated hypercholesterolaemia and hypertension (HT) among ED patients and to evaluate the effects of a formal referral back to the general practitioner (GP) for further management.
  
  
  METHODS
  This was a cross-sectional study of ED patients with follow up, if indicated. Patients aged ≥35 years, without substantial illness or communication difficulties, were enrolled. Data were collected using a researcher-administered questionnaire, a point-of-care Accutrend® Plus System machine (Roche Diagnostic Australia Pty Ltd, Castle Hill, NSW, Australia) and digital sphygmomanometer. Patients with total cholesterol (TC) ≥6.0 mmol/L and/or BP ≥140/90 were given a referral letter and advised to consult their GP. The investigators made follow-up telephone calls 5 weeks later.
  
  
  RESULTS
  Of 827 presentations, 534 patients were enrolled (mean age 56.7 ± 13.3 years, 300 [56.2%] male). One hundred and eleven patients (20.7%, 95% CI 17.5-24.5) had TC ≥6.0 mmol/L. Patients with/without elevated TC differed significantly (P < 0.05) in regard to age, gender, GP ownership and attendance, and previous screening. Sixty-six patients consulted with their GP. Thirty had their TC levels retested, 18 received dietary/lifestyle advice and four had lipid-lowering medication prescribed or adjusted. Ninety-six patients (18.0%, 95% CI 14.9-21.6) had HT. Whereas 53 consulted their GP, no action was taken in 43 cases. Investigations were ordered for three and nine had antihypertensive medication prescribed or adjusted.
  
  
  CONCLUSIONS
  Substantial proportions of ED patients have undiagnosed and undertreated hypercholesterolaemia and/or HT. GP referral initiated interventions for many patients with hypercholesterolaemia, but fewer with HT. The ED has potential as a useful venue for the opportunistic screening of hypercholesterolaemia.
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Tan
authors.forename: David McDonald
authors.initials: DM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001315:Australia; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis* / Q000628:therapy; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D009517:New South Wales; D019095:Point-of-Care Systems; D012017:Referral and Consultation; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002784:Cholesterol