title: Targeted case finding in the prevention of cardiovascular disease: a stepped wedge cluster randomised controlled trial.
abstract: BACKGROUND
  Individuals at high risk of cardiovascular disease (CVD) are undertreated.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a programme of targeted, nurse-led case finding for CVD prevention in primary care.
  
  
  METHODS
  Targeted case finding for CVD prevention was implemented in urban West Midlands general practices between February 2009 and August 2012, and evaluated as a stepped wedge cluster randomised trial.
  
  
  METHODS
  Untreated patients aged 35-74 years and at ≥20% 10-year CVD risk were identified, invited for assessment by a project nurse, and referred to their GP for treatment initiation. The primary outcome was the proportion of high-risk patients prescribed antihypertensives or statins after exposure to the intervention compared with an equivalent period of time prior to exposure. Secondary outcomes included assessment of CVD risk factors.
  
  
  RESULTS
  In 26 sequentially randomised general practices the exposed group consisted of 2926 untreated high-risk patients identified at the start of the intervention, with 2969 patients identified at the start of the unexposed period. The trial was well balanced in terms of age, sex, and cardiovascular risk factors. In the exposed period 19.7% of patients were prescribed antihypertensives or statins, and 10.8% of patients in the unexposed period. After adjustment for clustering and temporal effects the risk difference was 15.5% (95% CI = 3.9 to 27.1, P = 0.009). Assessment of lipid levels increased significantly, at 26.4% (99% CI = 5.3 to 47.5, P = 0.001) CONCLUSION: Targeted case finding programmes can increase the number of high-risk patients started on antihypertensive and statin treatment.
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham.
authors.forename: Karla
authors.initials: K
authors.lastname: Hemming
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham.
authors.forename: Ronan
authors.initials: R
authors.lastname: Ryan
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.affiliation: MyTime Active, Vision Point, Tipton, West Midlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Westerby
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham.
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011320:Primary Health Care; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: CVD risk; cardiovascular diseases; case-finding; nurse-led; prevention; primary care; randomised controlled trials