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83 Guidelines for cardiovascular disease prevention: what’s time got to do with it?
  1. Hálfdán Pétursson1,2,
  2. Minna Johansson3,4,
  3. Thomas Mildestvedt5,6,
  4. Peder A Halvorsen7,8
  1. 1Department of Family Medicine, University of Iceland, Reykjavik, Iceland
  2. 2Omtanken Kållered Primary Care Centre, Mölndal, Sweden
  3. 3Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gotheburg, Sweden
  4. 4Närhälsan Herrestad Primary Care Centre, Uddevalla, Sweden
  5. 5Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  6. 6Minde Medical Center, Bergen, Norway
  7. 7Department of Community Medicine, UiT – the Arctic University of Norway, Tromsø, Norway
  8. 8Byhagen Medical Center, Alta, Norway


Background Guidelines for prevention of cardiovascular disease have shown a continuing trend of lowering treatment goals and thresholds for initiation of treatment. As a result a larger proportion of the population has been defined as eligible for treatment. Arguably, in contemporary health care this is among the most salient examples of overdefinition of disease, which is a major cause of overdiagnosis. In most cases no cost-benefit analysis or analysis of the opportunity costs and treatment burden for patients has been performed before new guidelines are issued. Each new guideline expands the obligations of primary care clinicians, which may diminish their ability to provide care for other patient groups. Recently, the concept of ‘time needed to treat’ has been introduced to inform decision makers about important implications when new guidelines expand preventive care. This expansion may pose a threat to societal and health care sustainability.

Aim and learning objectives To discuss challenges related to implementation of guidelines for prevention of cardiovascular disease. The workshop will give an opportunity to discuss how the guideline recommendations are translated into clinical practice and to reflect on the feasibility and sustainability of current recommendations.

Methods and timetable The workshop will combine short presentations, digital interaction and collegial discussion. Current guideline recommendations and relevant evidence will be presented using blood pressure and hyperlipidemia as examples. Challenges will be discussed, including healthcare sustainability, burden of treatment, and multimorbidity.

We start with four focused presentations (40 min):

  • From risk reduction to postponement: Benefit of statin therapy revisited (Halvorsen).

  • Blood pressure – how low to go? (Pétursson).

  • To screen or not to screen? Cost–effectiveness analyses in recent guidelines (Mildestvedt).

  • Opportunity costs of preventive health care: Time needed to treat (Johansson).

Next, we invite workshop participants to share their views and experience using digital feedback, group discussions and a plenary discussion (40 min).

A summary and take home messages will follow (10 min).

Conclusions This workshop will provide participants with important perspectives on guidelines in the context of cardiovascular disease prevention. We highlight how overdefinition of disease may nudge clinicians to spend increasing amounts of time in the pursuit of treatment goals that may ultimately burden their patients out of proportion to the marginal benefits. After this workshop participants will be empowered in how they can take a holistic and sustainable approach to cardiovascular disease prevention and spend available time wisely.

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