Grote discrepanties tussen Europese, Nederlandse en Belgische criteria voor primaire cardiovasculaire preventie met statinen in de huisartsenpraktijk

To determine the differences in prescribing advice for statines in primary cardiovascular prevention, applying different protocols, in a first-line setting.

Method

In February-March 2000, at the general practice ‘Medicine for the People’ in Deurne-Antwerp, Belgium, all contacts with patients known with at least one cardiovascular risk factor and no signs of cardiovascular disease were included in the study. The absolute risk of developing cardiovascular disease in the next 10 years was calculated per patient according to the protocols of the ‘European Society of Cardiology’ (ESC) and the Dutch College of General Practitioners (NHG) and it was determined whether these protocols advised prescription of statines. It was also determined if the Belgian criteria for repayment of statines, developed by the Rijksinstituut voor Ziekte- en Invaliditeitsverzekering (RIZIV) were met.

Results

The study group comprised 143 patients with a mean age of 66 years, of which 51 (36) were men. According to the RIZIV criteria 75 (52) patients of these 143 were eligible for the repayment of statines. The NHG protocol advised to prescribe statines for 4 (3) patients and the ESC protocol for 69 (48) patients. Of the 75 patients who were considered for repayment, 34 (45) according to the ESC protocol and 74 (99) according to the NHG protocol did not need statines. Also, in the whole study population, 28 (20) patients needed statines according to ESC and 3 (2) patients according to NHG, but they could not get repayment for statines according to the RIZIV. The ESC protocol estimated the risk per patient on average 8.5 (95 confidence interval: 7.1-9.8; p < 0.0001) higher than the NHG protocol.

Conclusion

The NHG protocol estimated the risk significantly and markedly lower than the European protocol, although they are both based on the same Framingham data. There also existed a weak concordance between both protocols. The RIZIV criteria were not ‘evidence-based’. They incited to an irrational and wasting prescribing behaviour. There is a need for an integrated guideline for primary cardiovascular prevention and for the adjustment of the RIZIV criteria.