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Canadian Journal of Cardiology

Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review

  • Mostafa Alabousi
    Affiliations
    University of Ottawa, Ottawa, Ontario, Canada
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  • Peri Abdullah
    Affiliations
    York University, Toronto, Ontario, Canada
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  • David A. Alter
    Affiliations
    Toronto Rehabilitation Institute and Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    University of Toronto, Toronto, Ontario, Canada
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  • Gillian L. Booth
    Affiliations
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    University of Toronto, Toronto, Ontario, Canada

    Division of Endocrinology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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  • William Hogg
    Affiliations
    University of Ottawa, Ottawa, Ontario, Canada

    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Bruyère Research Institute, Ottawa, Ontario, Canada
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  • Dennis T. Ko
    Affiliations
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    University of Toronto, Toronto, Ontario, Canada

    Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Douglas G. Manuel
    Affiliations
    Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    Bruyère Research Institute, Ottawa, Ontario, Canada
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  • Michael E. Farkouh
    Affiliations
    University of Toronto, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre and Cardiovascular Division, University Health Network, Toronto, Ontario, Canada
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  • Jack V. Tu
    Affiliations
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    University of Toronto, Toronto, Ontario, Canada

    Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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  • Jacob A. Udell
    Correspondence
    Corresponding author: Dr Jacob A. Udell, Cardiovascular Division, Peter Munk Cardiac Centre, Toronto General Hospital and Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario M5S 1B1, Canada. Tel.: +1-416-351-3732 ×2459; fax: +1-416-351-3746.
    Affiliations
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

    University of Toronto, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre and Cardiovascular Division, University Health Network, Toronto, Ontario, Canada

    Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
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      Abstract

      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’ on the basis of the most successful US health plans were used 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, whereas 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, and American indicators were generally below target (61.5%, 43.0%, and 63.6%, respectively). Canada and the US showed 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%). Screening for tobacco use (72.2%) and counselling rates (73.8%) in the US were above target.

      Conclusions

      Substantial variation exists in cardiovascular risk factor care across North America. Standardized reporting, dissemination of practice guidelines, and setting explicit goal-directed targets for performance might facilitate improvement.

      Résumé

      Introduction

      La prise en charge des facteurs de risque cardiovasculaire en Amérique du Nord n’a pas fait l’objet d’études comparatives. Nous avions pour objectif de déterminer la performance actuelle au Canada et aux États-Unis (É.-U.).

      Méthodes

      Nous avons procédé à un examen systématique de Medline et d’EMBASE (jusqu’au 1er juin 2014). Les études admissibles faisaient état des taux de dépistage, de sensibilisation, de traitement ou de maîtrise de l’hypertension, de la dyslipidémie, du diabète et du tabagisme. Nous avons utilisé les « cotes » de performance catégoriques s’appuyant sur les régimes de santé les plus prospères des É.-U. pour classifier les taux comme étant sous-optimaux (< 50 %), sous les cibles (50 %-70 %), au-dessus des cibles (70 %-90 %), ou optimaux (> 90 %).

      Résultats

      Nous avons inclus un total de 127 études faisant état de 10 510 324 individus de l’Amérique du Nord. Pour ce qui est de l’hypertension, les taux de sensibilisation (84,3 %) et de traitement (82,0 %) au Canada et aux É.-U. (82,7 % et 75,6 %, respectivement) se situaient au-dessus des cibles, tandis que les taux de maîtrise dans les deux pays se situaient sous les cibles (68,1 % vs 51,8 %, respectivement). Pour ce qui est de la dyslipidémie au Canada, les taux de sensibilisation, de traitement et de maîtrise (42,7 %, 40,9 % et 41,5 %, respectivement) étaient considérés comme étant sous-optimaux, alors que les indicateurs des É.-U. se situaient généralement sous les cibles (61,5 %, 43,0 % et 63,6 %, respectivement). En ce qui concerne le diabète, le Canada et les É.-U. montraient des taux de sensibilisation (88,2 % vs 86,8 %) et de traitement (82,3 % vs 82,5 %) au-dessus des cibles. Cependant, la maîtrise de la glycémie était sous-optimale au Canada (35,3 %), et sous les cibles aux É.-U. (58,8 %). Les taux de prévalence absolue du tabagisme au Canada ont connu un déclin modeste de 1999 à 2013 (25,2 % à 14,6 %). Le dépistage de l’utilisation du tabac (72,2 %) et les taux de counseling (73,8 %) aux É.-U. se situaient au-dessus des cibles.

      Conclusions

      Il existe une variation substantielle entre la prise en charge des facteurs de risque cardiovasculaire en Amérique du Nord. Les rapports normalisés, la diffusion des lignes directrices de pratique et l’établissement de cibles explicites orientées vers l’objectif de performance aideraient à l’amélioration.
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