The new Primary Care and Risk Factor Management (PCRFM) nucleus of the European Association of Preventive Cardiology: A call for action

Abstract

In recent decades, cardiovascular mortality has reduced significantly. Among others, improved treatment options for cardiovascular disease (CVD) and a reduction of smoking since the 1960s have contributed to this decline. In many countries, smoking in public areas is prohibited. However, western dietary habits, including foods high in sugar, salt and fat, and lack of exercise are still persistent, leading to obesity, diabetes and hypertension. Yet, despite numerous guidelines on prevention and treatment of CVD with medication and lifestyle management, the incidence of CVD is still increasing in many countries, fuelled by rising obesity levels, sedentary lifestyles and increased longevity. In particular in the southern hemisphere CVD is on the increase, with high rates of obesity, diabetes and hypertension. Demographics are changing in low and middle income countries, fuelling the rise of chronic diseases and a persistent burden of infectious diseases overwhelming the limited health care resources. In western countries survival after CVD events has successfully improved; however, at the price of more patients living with chronic CVDs. These developments will lead to an increased demand on healthcare services now and in the years ahead for both the prevention and the management of CVD. The organisation and continuity of care through the various layers of the different national healthcare systems is challenging and calls for close collaboration between hospital specialists, general practitioners (GPs) and other primary care workers in the battle against CVD. GPs are key in identifying patients at risk of CVD and providing individualised, risk stratified preventive care. GPs, primary care nurses and other members of the primary care team have longstanding relationships with patients from cradle to grave and have frequent contacts with those enlisted. In adults, CVD or risk factors are in the top 10 of reasons to consult the general practice. Thus, primary care professionals are in general the first to identify changes in patients’ CVD risk factors. The 2016 European Guidelines on cardiovascular disease prevention in clinical practice recommend the prevention of CVD to be delivered in all healthcare settings, including primary care. It further recommends that GPs, nurses and allied health professionals such as physiotherapists, dieticians and psychologists should work together as a team to provide the most effective multidisciplinary care. General practice can offer comprehensive management for patients with CVD, including those with multiple comorbid conditions. Nevertheless, more implementation of individualised risk-based prevention that focuses on all aspects of lifestyle and risk factor management is needed. Important in this perspective of multi-morbidity is the