Survey of risk factors in coronary heart disease (SURF CHD) II: rationale, methods for a novel recruitment strategy and preliminary results
Authors: Marza Florensa A , Vaartjes I , Klipstein-Grobusch K , Zhao M , Cooney MT , Graham I , Grobbee DE 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): European Association of Preventive Cardiology

Introduction
SURF CHD (Survey of Risk Factors in Coronary Heart Disease) is a clinical audit on risk factors and secondary prevention among CHD patients. The first wave of the study showed usefulness of the tool and poor control of risk factors, however the centres were identified by personal contacts. A more formal recruitment strategy was required to increase representativeness in the second wave of the study (SURF CHD II). Purpose: SURF CHD II aims to simplify recording and assessment of risk factor management and medication in CHD patients, while using a novel recruitment strategy that improves representativeness of results and provides a wider picture of secondary prevention of CHD. Methods: The survey is conducted electronically during routine outpatient visits. Data on demographics, risk factors, laboratory and physical measurements and medications is collected and summarized. The novel recruitment strategy is based on the pre-existing network of a renowned association of preventive cardiology, which designates a National Cardiovascular disease Prevention Coordinator (NCPC) for several countries. NCPCs were invited to participate in the clinical audit; selected national cardiac societies were invited to pilot recruitment in countries without a designated NCPC; and clinicians that independently showed interest in SURF were welcome to participate too. The SURF team and interested country representatives held meetings to discuss a tailor-made approach for the implementation of the audit in each country. Results: A total of 48 NCPCs, 11 national cardiac societies and 9 individual contacts were invited to SURF. In 18 meetings with country representatives, enrolment of centres adapting to the countries’ characteristics were discussed. To date, 95 centres in 31 countries have agreed to participate and have enrolled 6145 participants: 88 in Eastern Mediterranean, 4786 in Europe, 108 in the Americas, 1069 in South East Asia and 13 in Western Pacific. 80.11% of the centres are public and 96.73% are located in urban areas. 25.21% of participants were female and mean age was 63.82 ± 18 years. 75.99% of the study population were overweight or obese and 16.6% were smokers. Blood pressure lower than &lt;140/90mmHg was reported in 61.05% of participants, 20.58% had LDL &lt;1.8 mmol/l and 39.58% had HbA1c &lt; 7%. 27.15% of participants attended cardiac rehabilitation. South East Asia recorded the lowest prevalence of overweight and obesity and LDL levels. Lowest use of statins was recorded in Europe (78.94%), and of angiotensin-converting enzyme inhibitors in the Americas (14.18%). Conclusions: The recruitment strategy based on the preventive cardiology association’s network is successful. Preliminary results indicate regional variations in risk factors and secondary prevention. SURF will continue to collaborate with NCPCs national cardiac societies to promote the survey and achieve a broader insight on secondary prevention of CHD with a simplified tool.