Coronary Heart Disease Prevention For Diabetic Patients In Primary Care - An Audit of Clinical Practice

Background: Type 2 diabetes mellitus (T2DM) represents a state of increased cardiovascular risk with the prognosis of diabetic patients with cardiovascular disease (CVD) much worse. The imperative on physicians, principally those in primary care, is to focus on strategies to reduce cardiovascular risk factors in patients with established diabetes. The main risk factors for CVD are hypertension, dyslipidemia and hyperglycemia. This audit reviewed clinical practice at a GP surgery in the drug management of cardiovascular risk factors in diabetic individuals who had suffered a previous cardiovascular event. Current clinical practice was compared with the standards as set out in The Quality and Outcomes Framework (QOF) guidance 2011/12.Methods: Analysis was carried out by collecting data from the general practice database system containing over 317 patients with a confirmed diagnosis of T2DM. Variables collected included patient demographic details, diagnostic data, previous coronary vascular interventions and most recent cardiovascular risk factor measurements (blood pressure, total cholesterol levels and glycaemic levels (HbA1c)). Multivariate analysis was performed to examine the relationship between a confirmed diagnosis of diabetes and cardiovascular sequelae. Patients were classed into 4 standards (gold, silver, bronze and none) as per defined by QOF guidance based on their cardiovascular risk factors.Results: Patients were excluded if they had a confirmed diagnosis of type 1 diabetes mellitus (n=19) or had no diagnosed cardiovascular pathology secondary to diabetes including myocardial infarction, heart failure, angina or left ventricular systolic dysfunction (n=258). A total of 59 patients were thus included in the audit analysis. Multivariate analysis noted a clear relationship between a diagnosis of type 2 diabetes and cardiovascular disease sequelae (p-value= 0.002). Results demonstrated that 59% of patients fell within in gold standard, 3.3% of patients fell within the silver standard, 22% of patients fell within the bronze standard and 15.3% failed to meet any standard cardiovascular risk standard.Conclusions: There is scope for improved management within the practice since 40.6% of diabetic patients have need for reduction in their cardiovascular risk factors to attain optimum control. Cardiovascular risk factors that primarily require treatment include improved treatment of glycaemic levels and blood pressure.