Efficacy of personalized family doctor contract services on the risk factors of atherosclerotic cardiovascular disease in high-risk people / 中华全科医师杂志

Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.

Knowledge of the disease and demands of medical intervention in high-risk individuals of arteriosclerotic cardiovascular diseases: a qualitative study / 中华全科医师杂志

Objective:To investigate the knowledge of the disease and demands of medical intervention in high-risk individuals of arteriosclerotic cardiovascular diseases (ASCVD).Methods:The 10-year ASCVD incidence risk prediction model was used to screen ASCVD high-risk individuals from Luohu district of Shenzhen city. From October 2018 to April 2019,a semi-structured in-depth interview was conducted among ASCVD high-risk individuals selected by stratified sampling method according to age, gender and educational level. The original data were analyzed with Colaizzi′s seven-step analysis method.Results:Total 37 interviewees were enrolled with an average age of (65.2±8.9) years and with an average ASCVD risk value of (14.2±3.2). Three themes were extracted from the interview, including: (1) Majority interviewees had better Knowledge about the hazards and risk factors of ASCVD; (2) Most of the interviewees had lower medical demands; (3) The interviewees were more likely to focus on symptomatic diseases or diseases disturbing them.Conclusions:The asymptomatic high-risk ASCVD individuals generally have better awareness of ASCVD and less demands for intervention. The result indicates that for health education, not only the knowledge, but also the attitude and behavior should be enhanced.

Knowledge requested by patients with coronary artery disease after stent implantation / 中华全科医师杂志

Objective To survey the knowledge requested by patients with coronary artery disease (CAD) after stent implantation.Methods A survey on CAD and stent-related knowledge requested by CAD patients with stent implantation was conducted with a self-designed questionnaire from September 2013 to November 2013.Total 362 patients (235 males and 127 females) aged (67 ± 12) years participated in the survey in Yuetan Community Health Service Center and Fuxing Hospital in Beijing.Open questions and heuristic questions were used together during the survey.Results The knowledge requested by patients were:diet management(255,70.4％),side effects of medication(241,66.6％),management of physical activity (221,61.0％),prevention of CAD(181,50.0％),withdrawal of medication(176,48.6％),the life of stents (168,46.4％),post-operation check-up items (162,44.8％),the causes of CAD (156,43.1％)and drug mechanisms(134,37.0％).Patients with stent implantation less than one year requested more knowledge about the cause of CAD (x2 =37.4,P ＜ 0.001),life-time of stent (x2 =39.9,P ＜0.001),prevention of CAD (x2 =13.4,P =0.001),post-operation check-up items (x2 =21.2,P =0.001) and requested less knowledge about withdrawal of medication (x2 =9.56,P =0.008),diet management (x2 =6.49,P =0.04) than those with more than one year.Patients aged ＜ 70 years requested more knowledge about the cause of CAD (x2 =31.6,P ＜ 0.001),prevention of CAD (x2 =9.99,P =0.007),life-time of stent (x2 =79.1,P ＜ 0.001),side effects of medication (x2 =7.84,P =0.02) than patients aged ＞ 70 years.Patients with education higher than junior high school requested more knowledge about the cause of CAD (x2 =26.6,P ＜ 0.001),prevention of CAD (x2 =14.4,P =0.001) and life-time of stents (x2 =7.82,P =0.02) than those with education lower than junior high school.Patients with education higher than junior college requested more knowledge about the cause of CAD (x2 =26.6,P ＜ 0.001) and post-operation check-up items (x2 =10.7,P =0.005) than those with education lower than junior college.Conclusion Some factors affect the knowledge requested by patients with coronary artery disease (CAD) after stent implantation,which should be considered in health education for CAD patients.

Survey on clinical knowledge of coronary artery disease management in general practitioners in Beijing / 中华全科医师杂志

A survey on clinical knowledge of coronary artery disease (CAD) management in general practitioners (GPs) in Beijing was conducted from March to September,2013.The questionnaire contained 4 cases (stable angina pectoris,post-percutaneous coronary intervention,acute anterior myocardial infarction and acute inferior myocardial infarction) and related clinical questions.Five hundred questionnaires were distributed and 471 valid questionnaires were returned with a recovery rate of 94.2％.The correct rate was 87.3％ and 61.8％ for diagnosis and treatment of emergent events in acute anterior myocardial infarction; however,the correct rate for other knowledge was ranged between 23.4％ and 40.6％.The correct rate increased with the educational levels in 5/11 items(P ＜ 0.01)and increased with the professional titles(P ＜ 0.001)in 3/11 items,which was not associated with the attendance of training or frequency of training attendance.The results indicate that clinical knowledge of CAD management for GPs in Beijing should be improved and the training methods should be focused on the clinical capacity.

Survey on knowledge of chronic heart failure and influencing factors in general practitioners in Beijing / 中华全科医师杂志

Objective To investigate the knowledge of chronic heart failure (CHF) and influencing factors in general practitioners (GP) in Beijing.Methods A self-designed questionnaire contained total 28 items,including basic knowledge of CHF,non-drug management,drug management and other management ; clinical cases were used to test clinical ability in 7 items.The questionnaire survey was conducted among GPs who participated in continuing education courses from 16 counties/districts in Beijing during January to June 2013.Results Total 720 questionnaires were distributed and 657 valid questionnaires were returned with a recovery rate of 91.3％.Total scores was 60.6.Scores of basic knowledge,non-drug management,drug management and other management was 63.1,76.9,44.0 and 56.9,respectively.There were statistical differences in scores of basic knowledge,non-drug management,drug management and other management between GPs with different diploma (F value:36.8,5.8,21.6,12.2,respectively; P ＜0.01) ; there were significant differences in scores of basic knowledge and drug management among GPs with different working years (F value:15.1 and 17.4,respectively ; P ＜ 0.01) ; there was significant difference in scores of drug management among GPs with different professional title (F =7.69,P ＜ 0.01).Only for GPs with junior college diploma,the scores of basic knowledge and drug management in GPs with working ≥20 y were higher than those working ＜ 20 y(P ＜ 0.01).The accuracy of clinical ability in GPs with junior college diploma,undergraduate diploma and post-undergraduate diploma was 39.6％,41.6％,41.8％ (P ＞ 0.05).Conclusions The knowledge of CHF is less desirable in GPs of Beijing,so that measures should be taken to improve the GP's knowledge of CHF.

Analysis of risk factors for peripheral arterial disease in type 2 diabetic patients / 中国医师进修杂志

Objective To analyze the prevalence of peripheral arterial disease (PAD) in type 2 diabetic patients and its association with traditional and non-traditional risk factors. Methods A total of 420 type 2 diabetic patients with duration exceeding 1 year and without acute myocardial infarction, unstable angina,and infection were evaluated. PAD was diagnosed by ankle-brachial index ≤0.90. Risk factors included age, gender, body mass index, smoking, hypertension, diabetes duration,glycated hemoglobin A[C ( HbA_1C ), uric acid, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol(HDL-C),high sensitive C reactive protein(hs-CRP),fibrinogen,and urinary albumin excretion rate (UAER). Results The prevalence rate of PAD was 16.4%(69/420). Older age, longer diabetes duration,lower HDL-C, higher UAER, hs-CRP and fibrinogen were associated with PAD. Multiple Logistic regression revealed that only age, UAER, hs-CRP and fibrinogen levels were independent risk factors. The prevalence rate of PAD was 4.7%(2/43), 12.9%(27/209) and 23.8%(40/168) in patients of less than 50 years old,50-70 years old and more than 70 years old, and was 7.9%( 14/177),9.3%( 11/118) and 35.2% (44/125) in different hs-CRP group (hs-CRP < 1 mg/L,l-3 mg/L, >3 mg/L), and was 9.7% (30/310) ,34.4%(33/96) and 42.9%(6/14) in normoalbuminuria, microalbuminuria and macroalbuminuria, and was 12.1%(43/356) and 40.6%(26/64) in different fibrinogen levels group (≤4 g/L and > 4 g/L). Conclusions The prevalence rate of PAD is higher in type 2 diabetic patients. Non-traditional cardiovascular risk factors may be involved in the development of PAD.

The relationship study between insulin resistance and the risk factors of coronary heart disease as well as the severity of coronary lesions / 中国介入心脏病学杂志

Objective To investigate the mechanism of insulin resistance (IR) with coronary heart disease (CHD) by the relationship study between IR and the risk factors of CHD as well as the severity of coronary lesions. Methods One hundred and twenty three patients with at least one vessel ≥50% luminal narrowing were analyzed from our consecutive angiographic data base, excluding patients concomitant with hepatic, renal, pancreatic diseases, thyroid disorders and diabetes mellitus (DM) with insulin therapy. Oral glucose tolerance test (OGTT), blood lipid, plasma insulin were performed in all patients. Insulin resistance was assessed by homeostasis model assessment (HOMA) to investigate the relationship study between insulin resistance and the risk factors of CHD,severity of coronary lesions as well as the clustering of risk factors (hypertension, overweight, impaired glucose tolerance/DM, high serum triglycerides, low high density lipoprotein cholesterol). Results The level of IR was correlated with the levels of body mass index (BMI), fasting glucose, postprandial glucose, fasting insulin, postprandial insulin, hypertension, serum triglycerides, and high density lipoprotein cholesterol. Meanwhile the level of IR was associated with clustering of risk factors and the extent and the severity of coronary lesions. Conclusion Insulin resistance may be the basis for disease. In the primary and secondary prevention of CHD, we should not only treat syndromes but also reduce the level of IR.