Singapore Med J 2008; 49(4) : 311 Original Article Department of Primary Care, Universiti Kuala Lumpur Royal College of Medicine Perak, 3 Jalan Greentown, Ipoh 30450, Malaysia Chan SC, FRACGP Principal Lecturer Klinik TW Lee, 173 Jalan Pasir Puteh, Ipoh 31650, Malaysia Lee TW, FRACGP General Practitioner Klinik Teoh & Chan, 18 Jalan Besar, Batu Gajah 31000, Malaysia Teoh LC, FRACGP General Practitioner Klinik Catterall, Khoo and Raja Malek, Bangunan Ming, Jalan Bukit Nanas, Kuala Lumpur 50250, Malaysia Abdullah ZC, FRACGP General Practitioner Klinik Xavier, 633 Jalan Bagan Ajam, Butterworth 13000, Malaysia Xavier G, FRACGP General Practitioner Sim’s Medical Clinic, Kiat Siang Building, 12A Jalan Bendahara, Miri 98000, Malaysia Sim CK, FRACGP General Practitioner Kelinik Tan, 5469 Masjid Tanah, Malacca 78300, Malaysia Ng AC, FRACGP General Practitioner Klinik Ian Ong, 3A-09 Plaza 138, 138 Jalan Ampang, Kuala Lumpur 50450, Malaysia Ong ICH, FRACGP General Practitioner Ipoh Skin & General Clinic, 78 Jalan Yang Kalsom, Ipoh 30250, Malaysia Begum R, FRACGP General Practitioner Klinik Medijaya, 12 Jalan Harimau, Taman Century, Johor Bahru 80250, Malaysia Leong CC, FRACGP General Practitioner Correspondence to: Prof Chan Sook Ching Tel: (60) 5 2432 635 Fax: (60) 5 2432 636 Email: csching@rcmp. unikl.edu.my Audit on cardiovascular disease preventive care in general practice Chan S C, Lee T W, Teoh L C, Abdullah Z C, Xavier G, Sim C K, Ng A C, Ong I C H, Begum R, Leong C C ABSTRACT Introduction: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit. Methods: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards. Results: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics. Conclusions: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics. Keywords: cardiovascular disease preventive care, cardiovascular risk factors, disease prevention, general practice Singapore Med J 2008; 49(4): 311-315 INTRODUCTION Cardiovascular disease (CVD) is a major cause of mortality and morbidity worldwide, including Malaysia. An estimated 17 million people die of CVDs each year. (1) It accounted for 7.1% of hospitalisations and 22.9% of the deaths reported (14.5% heart disease and diseases of pulmonary circulation and 8.4% cerebrovascular diseases) in Malaysian government hospitals in 2004. (2) Data analysis of more than 500,000 participants in 14 intervention trials and three observational studies showed that 80%–90% of patients who developed clinically significant coronary heart disease (CHD) had at least one of four classical risk factors, namely: hypercholesterolaemia (> 6.22 mmol/L), hypertension (systolic blood pressure [BP] > 140 mmHg and/or diastolic BP > 90 mmHg), diabetes mellitus or smoking. (3,4) The INTERHEART study suggested that known conventional risk factors accounted for over 90% of the risk of myocardial infarction in both genders worldwide. (5) Of concern was the increased rate of hypertension, diabetes mellitus and obesity. There is a huge opportunity for prevention. Risk factor modifications have been unequivocally shown to reduce mortality and morbidity. Smokers have about twice the risk of dying from CHD, compared with lifetime nonsmokers. This excess risk is reduced by about half among ex- smokers after only one year of smoking abstinence. (6) It is estimated that in patients with stage 1 hypertension (systolic BP, 140–159 mmHg and/or diastolic BP, 90–99 mmHg) and additional cardiovascular (CV) risk factors, achieving a sustained 12 mmHg decrease in systolic BP for ten years will prevent one death for every 11 patients treated. (7) In short-term, controlled clinical trials, a 1% reduction in LDL-cholesterol levels with statins on average reduces the risk for hard CHD events (myocardial infarction and CHD death) by approximately 1%. (8) Active exercise produces a 45% reduction in risk and achieving an ideal body weight gives up to a 55% lower risk of heart attack as compared to the obese. Therefore, a major strategy adopted to reduce the CVD burden is by primary and secondary prevention through the screening and management of CV risk factors, such as cigarette smoking, alcohol intake, physical inactivity, hypertension, obesity, diabetes mellitus, and hyperlipidaemia. The cornerstones of primary prevention include avoidance of tobacco, healthy dietary patterns, weight control, appropriate exercise and controlling hypertension, hyperlipidaemia and diabetes mellitus. (9) General practitioners (GPs) have a central role in the prevention, detection and management of CV risk factors as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. Evidenced-based guidelines for the primary prevention of CVD and stroke are available. (9,10) However, it is well known that there is a gap between what is recommended and what is actually practised. There is little locally published data on CVD