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

The 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.CHD 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.Communication 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.Hypertension, dyslipidaemia and diabetes mellitus are prime risk factors for coronary heart disease (CHD). Global clinical practice guidelines recommend controlling these risk factors as a management strategy to mitigate the risk of recurrent CHD. Hence, physicians managing these patients should focus on treating these modifiable risk factors to evidence-based targets. However, most CHD patients failed to reach these targets [1,2]. In Singapore, deaths from CHD has only declined marginally from 19.8% in 2007 to 19.2% in 2009 [3] Moreover, Ho KT et al [4] reported that 70% of CHD patients in a cohort study of CHD patients from the Singapore National Cardiac Registry did not achieve a serum LDL-C target of < 100 mg/dL (2.6 mmol/L). 94% of the very high risk patients did not achieve the stringent serum LDL-C target of < 70 mg/dL (1.8 mmol/L).Locally, patients with CHD are often discharged to primary care from cardiolog