Patient characteristics and reasons for discontinuation in a cardiovascular risk management programme in The Netherlands

Abstract

Abstract Background Since 2010, an increasing number of patients have participated in a nurse-led integrated cardiovascular risk management programme in the Netherlands. Because it is important to understand which patients discontinue and why, when evaluating the effectiveness of the care programme, the aim was to identify the reasons for discontinuation. Methods Electronic health records of 3997 patients enrolled in a nurse-led integrated cardiovascular risk management programme that started on April 1st, 2010, were manually scrutinized for reasons for discontinuation between April 1st, 2010, and April 1st, 2018. In addition to death and moving to a diabetes care programme, we describe 7 different reasons why patients discontinued the programme and compared the patient characteristics of those who discontinued the programme without specific reasons with those who remained in the care programme for 8 years. Results Between April 1st, 2010, and April 1st, 2018, 1,190 participants (29.8%) discontinued the CVRM care programme, of whom 271 participants died (6.8%) and 195 were transferred to a diabetes care programme (4.9%). The remaining 724 patients (18.1%) participated 5 years before discontinuation. Of these, 67 (9.3%) had a previous cardiovascular event at the start of the programme. In 355 patients, a specific reason for discontinuation was not found. At baseline, these patients less frequently had a history of CVD than those who continued the programme for 8 years (1.7 vs 22.6%), were younger (62 vs 67 years), had less registered cardiovascular comorbidity (atrial fibrillation: 1.1 vs 7.2%; congestive heart failure 0.3 vs 1.2%; chronic kidney disease 0.0 vs 4.5%), were more often smokers (13.0% vs 4.3%) and took blood pressure- and lipid-lowering drugs twice as often. Conclusions Participants who drop out of a nurse-led integrated CVRM programme without any reason clearly seem to be a selective population with a different cardiovascular risk profile than those continuing the programme. Apart from the viewpoint of providing adequate health care adapted to the wishes of the patient, these findings are important to consider when evaluating the effectiveness of the programme.