Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Cardiovascular Disease.

Abstract

Background and objective: Cardiovascular diseases remain to be the leading cause of death in the Philippines. Screening may lead to improvement of clinical outcomes if such conditions are detected and managed early and appropriately. The benefits of screening for a particular disease must be balanced with potential harms due to mislabeling or adverse effects of treatment, as well as socio-economic implications in the primary care setting. The main objective of this clinical practice guideline initiated by the Department of Health and the National Institutes of Health is to provide evidence-based recommendations that will help primary care physicians in detecting selected cardiovascular diseases among apparently healthy, asymptomatic individuals, while considering the socio-economic implications of the diagnostic screening tests.

Methods: We performed a systematic synthesis of evidence to address screening for six priority cardiovascular conditions among asymptomatic, apparently healthy adult Filipinos: 1) familial hypercholesterolemia, 2) coronary artery disease, 3) asymptomatic carotid artery stenosis, 4) peripheral arterial disease, 5) abdominal aortic aneurysm, and 6) atrial fibrillation. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended by the Department of Health. The process included 1) generation of critical questions and critical outcomes, 2) retrieval of current and relevant evidence, 3) synthesis and assessment of the evidence base for these critical questions, 4) formulation of draft recommendations, 5) convening of a multisectoral stakeholder panel to discuss feasibility, values, and preferences, and assess the strength of the recommendations, and 6) planning for dissemination, implementation, impact evaluation, and updating.

Results: The CPG provides seven recommendations on six prioritized questions in the screening for certain cardiovascular disorders. After presentation of the evidence by the evidence reviewer experts and deliberation by the consensus panel, we came up with two statement recommendations for the question on screening for abdominal aortic aneurysm and one statement recommendation each for the rest of the clinical questions. The consensus panel made strong recommendations to screening for two conditions in asymptomatic and apparently healthy Filipinos, namely: familial hypercholesterolemia and abdominal aortic aneurysm (moderate).

Conclusion: Among asymptomatic, apparently healthy adult Filipinos, we recommend routine screening for two cardiovascular conditions: familial hypercholesterolemia and abdominal aortic aneurysm, with the latter being applicable only to men 60-80 years of age. These recommendations are offered to guide the primary care physician in screening key cardiovascular diseases and should not supplant but rather supplement the healthcare provider's sound clinical judgment.