Standardized arrangement for a guideline-driven treatment of the metabolic syndrome: the SAGE-METS study

ABSTRACT

Aim: To substantially increase awareness, treatment and effective control of the metabolic syndrome (MetS) and its components.

Subjects and methods: This is a pilot best practice implementation enhancement programme to reduce the estimated cardiovascular disease (CVD) risk in 628 MetS patients with or without diabetes or CVD by improving quality of care. A baseline visit was followed by action to improve adherence to lifestyle advice and drug treatment for CVD risk factors by physicians specifically trained to implement guidelines. Finally, after 6 months, a single-page form was completed, showing if patients were at CVD risk factor target. If not, there was an analysis of the reason why.

Results: The programme was effective in improving utilization of evidence-based treatment in 628 MetS patients. There was a substantially greater patient perception of MetS, an enhancement in compliance with lifestyle advice and increased prescription of evidence-based medication, leading to a 48% (p < 0.0001) improvement in estimated CVD risk. There was a substantial increase in the number of subjects on target for specific CVD risk factors.

Conclusions: This is the first study to increase adherence to multiple interventions for all MetS components on an outpatient basis, in both primary care and teaching hospital settings. Physician and patient education, distribution of printed guidelines and brochures, and completion of a single-page form motivated both physicians and patients to achieve multiple CVD risk factor guideline goals. The absence of a control group is a limitation of this study. Further work is also needed to establish if the improvements observed are sustained on a long-term basis.

Key words: :

• Awareness
• Best practice
• Metabolic syndrome
• Components
• Control
• Public healthcare
• Treatment

Acknowledgements

Statement on funding: This study was conducted independently under the auspices of the Regional Health Authority for Northern Greece – Central Macedonia; no company or institution supported it financially.

Co-investigators: Mandikou E, Health Centre (HC) of Langadas; Hartamba E, Sappes HC; Basagiannis C, Cardiology Clinic AHEPA Hospital; Dimopoulou SP, Ormylia HC; Karanasios D, Maditos HC; Thoma E, Deskati HC; Kelegouris I, and Papadopoulos I, Thermi HC; Symeonidis A, Paleohorio HC; Tziomalos K, and Kakafika A, 2nd Propedeutic Department of Internal Medicine, Hippocration Hospital; Savatis S, Kagiadaki H, and Papadimitriou M, 2nd Cardiology Clinic, Hippocration Hospital; Frangakis N, Cardiology Clinic Papanikolaou Hospital; Petridis D, Ehinos HC; Papathanakis C, Orestiada HC.

Declaration of interest: V. G. A, A. K, A. I. H, K. P, C. S, G. G, D. P. M, A. S, S. S, have given talks, attended conferences and participated in trials and advisory boards sponsored by various pharmaceutical companies. S. P. D, E. T, I. P, K. T, A. K, H. K, N. F, D. P, have attended conferences sponsored by various pharmaceutical companies. E. M, E. H, C. B, D. K, I. K, M. P, C. P, have no conflicts of interest with regards to the contents of this article.

Further contribution: The authors and co-investigators take full responsibility for the contents of the article, and thank the following employees of the Regional (Bureau) Authority of the Ministry of Health for Northern Greece-Central Macedonia for their contributions to the study: A. Trichopoulou (Department Head), D. Florinis, K. Kakafika.