Cardiovascular risk factor management performance in Canada and the United States: a systematic review
Alabousi M, Abdullah P, Alter DA, Booth GL, Hogg W, Ko DT, Manuel DG, Farkouh ME, Tu JV, Udell JA. Can J Cardiol. 2017; 33(3):393-404.
Background — Comparative cardiovascular risk factor care across North America is unknown. We aimed to determine current performance in Canada and the United States (US).
Methods — A systematic review was conducted of MEDLINE and EMBASE (to June 1, 2014). Eligible studies reported on screening, awareness, treatment, or control rates for hypertension, dyslipidemia, diabetes and smoking. Categorical performance ‘ratings’ based on the most successful US health plans were utilized to classify rates as suboptimal (<50%), below target (50%-70%), above target (70%-90%), or optimal (>90%).
Results — A total of 127 studies reporting on 10,510,324 individuals across North America were included. Hypertension awareness (84.3%) and treatment (82.0%) rates in Canada and the US (82.7% and 75.6%, respectively) were above target, while control in both nations was below target (68.1% vs. 51.8%, respectively). Canadian awareness, treatment, and control rates for dyslipidemia (42.7%, 40.9%, and 41.5%, respectively) were suboptimal, while American indicators were generally below target (61.5%, 43.0%, and 63.6%, respectively). Canada and the US demonstrated diabetes awareness (88.2% vs. 86.8%) and treatment rates (82.3% vs. 82.5%) above target. However, glucose control was suboptimal in Canada (35.3%), and below target in the US (58.8%). There was a modest decline in absolute smoking prevalence rates in Canada from 1999 to 2013 (25.2% to 14.6%). Both screening for tobacco use (72.2%) and counseling rates (73.8%) in the US were above target.
Conclusions — Substantial variation exists in cardiovascular risk factor care across North America. Standardized reporting, disseminating practice guidelines, and setting explicit goal-directed targets for performance may facilitate improvement.
Health care quality