Treat-to-target approach in managing modifiable risk factors of patients with coronary heart disease in primary care in Singapore: what are the issues?

Abstract

BackgroundThe key management strategy for established coronary heart disease (CHD) patients is to control the underlying risk factors. Further complications will be reduced when these risk factors are treated-to-target (TTT) as recommended by clinical practice guidelines. These targets include blood pressure (BP) lower than 130/80 mm Hg and LDL-cholesterol of less than 2.6 mmol/L and for those with type 2 diabetes mellitus (DM), HBA1c less than 7%. This article aimed to explore the issues affecting this approach from both the patients' and primary care physicians' (PCP) perspectives.MethodsThe study involved triangulation of research methods to determine the findings. Part A: focus group discussions to collect qualitative data from patients with CHD and from PCPs who were managing them in primary care. Part B: A subsequent questionnaire survey to determine the extent of their awareness of treatment targets for modifiable risk factors.ResultsCHD patients had variable awareness of the modifiable risk factors for CHD due to poor concordance between the PCPs' approach in managing the CHD patients and the latter's reception of information. 46% of participants knew their targets of BP control correctly; 11% of them were correct in stating their target for LDL-cholesterol control. Amongst these participants with DM (n = 146), 27% of them were correct in indicating their target of diabetic control.ConclusionsCommunication and practice barriers exist which hinder the treat-to-target approach in mitigating the risk factors for CHD patients. Incorporating this approach in routine clinical practice by PCPs has greater potential to achieve treatment targets for patients.

miRNA 206 and miRNA 574-5p are highly expression in coronary artery disease

“…From these 33 miRNA, miRNAs were selected for further analysis based on following criteria: (1) at least 5-fold up-regulated in patients as compared with controls, (2) a P <0.01 was considered statistically significant in patients as compared with controls and (3) the bioinformatic analysis revealed the potential target genes for the identified miRNAs and these target genes might be involved in the onset and development of CAD [ 21 – 23 ]. Two miRNAs were showed a significant differential expression between CAD patients and controls.…”

Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real-life cohort in Thailand

“… 27 A study in Singapore found that >80% of CAD patients did not know their LDL-C target because of poor, or lack of, communication regarding LDL-C targets between physicians and patients, suggesting that patients may not achieve their treatment targets. 34 Besides, many studies show a positive relationship between adherence to taking statins and achieving the LDL-C goal. 35 – 37 However, adherence to statin therapy declines over time; ACS patients had a 2-year adherence rate with statins of about 40%.…”

Production, Transmission, Pathogenesis, and Control of Dengue Virus: A Literature‐Based Undivided Perspective

“…Preventive measures should be the first and best choice in this case, such as the prevention of direct contact of blood or blood-derived products from the infected patients and infected vectors from the infected host [ 105 ]. Daytime is the most suitable time for biting Aedes mosquitoes; consequently, its contact can be diminished or avoided using the following techniques: By using nets (e.g., insecticide-treated nets) and mosquito repellents (e.g., coils, solids (sticks), aerosols, liquids, pump sprays, and nonsticky creams) By wearing gloves and other defensive clothing Through well-planed management of wastes and stored water By destroying the mature Aedes mosquitoes or larvae through applying some protective chemicals (e.g., N,N-Diethyl-3-Methylbenzamide, diethyl carbonate, metofluthrin, oil of lemon-eucalyptus, diethyl phthalate, ethyl hexanediol, and picaridin) [ 106 , 107 ]. …”

“…By destroying the mature Aedes mosquitoes or larvae through applying some protective chemicals (e.g., N,N-Diethyl-3-Methylbenzamide, diethyl carbonate, metofluthrin, oil of lemon-eucalyptus, diethyl phthalate, ethyl hexanediol, and picaridin) [ 106 , 107 ].…”

“…Formosan zoanthid BioMed Research International diethyl phthalate, ethyl hexanediol, and picaridin) [106,107].…”