Risikogerechte Behandlung in der kardiovaskulären Primär- und Sekundärprävention bei Teilnehmern am „Check up 35“

Background In 1998 a screening examination starting at the age of 35 according to §25 of the SGB V was instituted by the public health insurance schemes in Germany. This check up aims at the early detection, prevention and treatment of cardiovascular diseases. This study is evaluating which patients participate in the check up examination as well as their cardiovasular risk profile, the adequacy of their treatment according to their overall risk and the improvement of their treatment after the check up examination. Methods and patients The data of 1070 patients who had participated in the check up in the year 2004 from 10 different GP´s offices were retrospectively evaluated. For that purpose both, the check up form and the additional patient data available concerning physical examination findings, laboratory results, preexisting medical conditions, medical treatment and diagnostic procedures were evaluated. The overall risk of a cardiovascular incident according to the risk scores of Framingham, ARRIBA, PROCAM and SCORE Germany were calculated by using the program SPSS and further analysis was conducted. Results The cardiovascular risk profile of each patient with respect to the individual risk factors equals to a large degree the data of the “Bundesgesundheitssurvey´98”. The calculation of the overall risk according to different risk scores however varies remarkably. There is a comparatively generous medical treatment of single cardiovascular risk factors in contrast to a lack of treatment with drugs of high risk patients. On an absolute base more patients with a low overall risk are treated in the check up. The lack of sufficient treatment in the high risk population is not impaired by the check up. Discussion A majority of participants of the check up show at least one or several known CV risk factors prior to the check up examination. The number of newly diagnosed diseases or risk factors remains low. There is a generous medical treatment of single risk factors not rarely leading to an overestimated treatment with drugs in contrast to a low number of patients with a lack of treatment despite of their high cardiovascular risk constellation. This is not only the case before but also in the time after the check up examinations. The presently available risk scores for the calculation of the overall CV risk differ remarkable in respect of their risk estimation which makes the definition of a clear cut off line impossible. Conclusion There is a considerable need for improvement of the presently conducted check up as a mean of screening for CV diseases as its efficacy is too low especially in regard to the high risk sector and the secondary prevention. There is an urgent need for evaluated strategies of calculating the overall risk and of improving the medical treatment of high risk patients avoiding unnecessary medication of single risk factors in patients with low overall risk.