Improvement of early diagnosis of CVD in primary care patients with COPD or T2D

ESC Congress 2023 In the RED-CVD trial, it was shown that a proactive diagnostic intervention strategy improves early diagnosis of CVD in primary care patients with COPD and/or T2D.

Presented at the ESC Congress 2023 by: Amy Groenewegen, MD - Utrecht, The Netherlands

Introduction and methods

Patients with COPD or T2D have an increased risk of CVD. Despite the fact that these patients often participate in disease management programs, CVD remains undiagnosed in a large proportion of these patients. Therefore, the investigators of the RED-CVD-trial developed a new diagnostic strategy in order to uncover CVD at an early stage in primary care patients with COPD and/or T2D.

The RED-CVD (Reviving Early Diagnosis of CardioVascular Disease) trial was a cluster-randomized diagnostic trial in which patients with COPD or T2D who participated in disease management programs were enrolled. Primary care practices were randomized to diagnostic intervention or usual care (25 practices in each group). A total of 650 patients with COPD or T2D were included per arm. The diagnostic intervention consisted of three steps: (1) symptom questionnaire, (2) physical examination, NT-proBNP measurements and ECG, and (3) referral at the general practitioner discretion. Patients proceeded from step 1 to step 2, if they scored above a certain threshold. Similarly, patients proceed from step 2 to step 3 in case of abnormalities. The primary outcome was the number of new diagnosis of CVD after 1 year.

Main results

• A higher number of any new CVD diagnoses were detected in the intervention arm compared with the usual care arm (8.0% vs. 3.0%, respectively).
• The primary driver behind these new diagnoses were HF diagnoses, which occurred in 4.5% of patients in the intervention arm and 1.5% in the usual care arm. In particular, more cases of HFpEF were detected (3.2% in the intervention arm vs. 0.7% in the usual care arm).
• More patients with AF and CAD were detected in the intervention arm compared with the usual care arm (for AF: 2.1% vs. 0.8%, respectively; and for CAD: 2.6% vs. 1.4%, respectively).

Conclusion

The new diagnostic strategy of the RED-CVD trial more than doubled the number of new diagnoses of HF, AF, and CAD in primary care patients with T2D and/or COPD. “It is an easy to implement tool. It can be performed by practitioners during routine visits. All the components are available in primary care, it is relatively cheap and suitable for direct practical implementation”, according to the presenter Amy Groenewegen.

- Our reporting is based on the information provided at the ESC Congress 2023 -

Watch a video by Amy Groenewegen on this study