Use of lifestyle interventions in primary care for individuals with newly diagnosed hypertension, hyperlipidaemia or obesity: a retrospective cohort study
Date
2022-01-15
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Abstract
Objective: Lifestyle interventions can be efficacious in
reducing cardiovascular disease risk factors and are recommended as first-line interventions in England. However,
recent information on the use of these interventions in
primary care is lacking. We investigated for how many
patients with newly diagnosed hypertension, hyperlipidaemia or obesity, lifestyle interventions were recorded in
their primary care electronic health record.
Design: A retrospective cohort study.
Setting: English primary care, using UK Clinical Practice
Research Datalink.
Participants: A total of 770,711 patients who were aged
18 years or older and received a new diagnosis of hypertension, hyperlipidaemia or obesity between 2010 and
2019.
Main outcome measures: Record of lifestyle intervention
and/or medication in 12 months before to 12 months after
initial diagnosis (2-year timeframe).
Results: Analyses show varying results across conditions:
While 55.6% (95% CI 54.9–56.4) of individuals with an initial diagnosis of hypertension were recorded as having lifestyle support (lifestyle intervention or signposting) within
the 2-year timeframe, this number was reduced to 45.2%
(95% CI 43.8–46.6) for hyperlipidaemia and 52.6% (95% CI
51.1–54.1) for obesity. For substantial proportions of individuals neither lifestyle support nor medication (hypertension: 12.2%, 95% CI 11.9–12.5; hyperlipidaemia: 32.2%, 95%
CI 31.2–33.3; obesity: 43.9%, 95% CI 42.3–45.4) were recorded. Sensitivity analyses confirm that limited proportions
of patients had lifestyle support recorded in their electronic
health record before they were first prescribed medication
(diagnosed and undiagnosed), ranging from 12.1% for
hypertension to 19.7% for hyperlipidaemia, and 19.5% for
obesity (23.4% if restricted to Orlistat).
Conclusions: Limited evidence of lifestyle support for individuals with cardiovascular risk factors (hypertension,
hyperlipidaemia, obesity) recommended by national
guidelines in England may stem from poor recording in
electronic health records but may also represent missed
opportunities. Given the link between progression to cardiovascular disease and modifiable lifestyle factors, early
support for patients to manage their conditions through
non-pharmaceutical interventions by establishing lifestyle
modification as first-line treatment is crucial.
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Keywords
Disease prevention, cardiovascular disease, primary care, lifestyle intervention