Systematic review of international clinical guidelines for the promotion of physical activity for the primary prevention of cardiovascular diseases

Abstract

Background Cardiovascular diseases are the world’s leading cause of morbidity and mortality. An active lifestyle is one of the cornerstones in the primary prevention of cardiovascular disease. An initial step in guiding primary prevention programs is to refer to clinical guidelines. We aimed to systematically review clinical practice guidelines on primary prevention of cardiovascular disease and their recommendations regarding physical activity. Methods We systematically searched Trip Medical Database, PubMed and Guidelines International Network from January 2012 up to December 2020 using the following search strings: ‘cardiovascular disease’, ‘prevention’, combined with specific cardiovascular disease risk factors. The identified records were screened for relevance and content. We methodologically assessed the selected guidelines using the AGREE II tool. Recommendations were summarized using a consensus-developed extraction form. Results After screening, 27 clinical practice guidelines were included, all of which were developed in Western countries and showed consistent rigor of development. Guidelines were consistent about the benefit of regular, moderate-intensity, aerobic physical activity. However, recommendations on strategies to achieve and sustain behavior change varied. Multicomponent interventions, comprising education, counseling and self-management support, are recommended to be delivered by various providers in primary health care or community settings. Guidelines advise to embed patient-centered care and behavioral change techniques in prevention programs. Conclusions Current clinical practice guidelines recommend similar PA lifestyle advice and propose various delivery models to be considered in the design of such interventions. Guidelines identify a gap in evidence on the implementation of these recommendations into practice.

Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research

“…Reaching people with low SES by health promotion and prevention initiatives on a population level is challenging [57,58]. Our respondents stated that a combined approach of implementing a CVD prevention program in both PHC and community settings is needed to increase accessibility to the EBSP and to affect the prevalence of CVD, which is further supported by the literature [19]. On the one hand, according to the literature, general practice plays an important role in reducing socioeconomic inequalities by maintaining a trust-based relationship, facilitating patient-centered communication and premising personal targets tailored to the local community context [59,60].…”

“…This pre-implementation contextual analysis is part of the H2020 SPICES project, which intends to scale up packages of interventions for cardiovascular disease prevention in selected sites in Europe (France, UK, Belgium) and Sub-Saharan Africa (Uganda, South Africa). The Consortium developed the significant components of the intervention, referred to as “the evidence-based SPICES program (EBSP)”, based on systematic reviews of international guidelines [ 19 , 38 ]. The first component is risk profiling and communication for people between 40 and 75 years, applying the non-laboratory INTERHEART modifiable risk score [ 5 ].…”

“…Nurses play a critical role in expanding, connecting, and coordinating primary and community care [ 17 ] and have the ability to make a difference in areas such as patient advocacy and education, and people-centered care [ 18 ]. Clinical practice guidelines recommend active and systematic integration of lifestyle interventions for CVD prevention in PHC and community settings [ 19 ], adding to the importance of integrated care by general practitioners (GP) and practice nurses (PN) in general practice [ 20 , 21 ]. Such collaborations are only established to a limited extent in some contexts [ 22 ].…”

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

“…Current evidence demonstrates numerous strategies to reduce cardiovascular disease risk with strong consensus on the importance of raising awareness of risk factors and on the impact of lifestyle on health outcomes (Stewart et al, 2017;Díaz-Gutiérrez et al, 2019;Hassen et al, 2021). Clinical practice guidelines yet fail to consistently propose structured protocols to guide practitioners, and gaps in evidence are reported especially regarding strategies targeting vulnerable populations (Odorico et al, 2019;Aerts et al, 2021). Consequently, people with low socioeconomic status tend to benefit less from preventive care including lifestyle interventions (Coupe et al, 2018;Rosengren et al, 2019).…”

“…However, prevention-orientated services are not systematically provided in Belgian general practice. Clinical practice guidelines report various interprofessional collaboration models, including role expansion and task delegation in primary health care (Aerts et al, 2021). Integrated care delivered by physisiancs and nurses in general practice brings the opportunity to increase quality and accessibility of preventive care (Philips et al, 2015;Waller et al, 2016;Matthys et al, 2017;Srivarathan et al, 2019;Aerts et al, 2020).…”