Fewer people died or needed expensive long-term care when their physicians focused on the top risk factors for stroke and dementia, according to research reported in the Journal of the American Heart Association (JAHA).
The primary care doctors in the German study focused on high blood pressure, smoking, high cholesterol, diabetes, irregular heartbeat (atrial fibrillation) and depression. The researchers found that during a five-year period, the need for long-term care was cut 10 percent in women and 9.6 percent in men.
Based on data collected in a comparison district, 2,112 deaths were expected in the intervention group, but only 1,939 patients died.
“Primary prevention pays off,” said Horst Bickel, Ph.D., lead author of the study and senior researcher at the Department of Psychiatry at the Technical University of Munich in Germany. “Prevention measures have a potential for improving health in old age which has up to now not been satisfactorily exploited.”
He described these as “relatively simple” interventions, such as encouraging patients to:
- be more physically active;
- eat healthier foods;
- quit smoking;
- reduce high blood pressure and high cholesterol.
The study included nearly 4,000 people age 55 and older in rural Upper Bavaria, Germany. Their family doctors were given a brochure summarizing the recommendations, treatment guidelines and goals. Those patients were compared to 13,000 people in a nearby area who received the usual care without the focus on preventing stroke and dementia.
“We found that not only the risk of long-term care dependence was lower, but also that death rates decreased,” Bickel said. “In addition, the cost of inpatient treatment was reduced in the intervention region.”
Bickel said he’s confident the results can be applied in the United States and other Western populations that suffer from similar sedentary lifestyle-related illnesses. He points to smoking, lack of exercise and obesity as the main culprits.
“At the population level, even simple measures can lead to substantial achievements,” he said. “Our results are only one example for how health risks can be reduced through uncomplicated, routine treatment of risk factors in the framework of a real-world setting.”
Co-authors are Karl-Heinz Ander, M.D.; Monika Brönner, M.D.; Thorleif Etgen, M.D.; Hans Gnahn, M.D.; Othmar Gotzler, M.D.; Holger Poppert, M.D.; Klaus Pürner, M.D.; Dirk Sander, M.D.; and Hans Förstl, M.D.
Funding was primarily provided by health insurance company Allgemeine Ortskrankenkasse Bayern. Further support was provided by the German Stroke Foundation; Bayer Vital GmbH; Berlin-Chemie AG; Organon Parmaceuticals; Ratiopharm GmbH; Sanofi-Synthelabo Gmb; and TEVA Pharmaceutical Industries Ltd. Author disclosures are on the manuscript.
American Heart Association