• Suzanne Marchal, Monika Hollander, Marieke Schoenmakers, Michiel Schouwink, Jorik R Timmer, BiloHenk J GHJGCenter for Integrated Care, Dr. Spanjaardweg, 118025 BT, Zwolle, The Netherlands., Olof Schwantje, van 't HofArnoud W JAWJIsala, Dokter van Heesweg 2, PO Box 10400, 8000, GK, Zwolle, The Netherlands.Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.Zuyderland Medical Center, department of Cardiology, Heerlen, T, and Arno W Hoes.
• Julius Center for Health Sciences and Primary Care/ University Medical Center Utrecht and Utrecht University, Huispost Str. 6.131, PO Box 85500, 3508, GA, Utrecht, The Netherlands. s.marchal@umcutrecht.nl.
• Bmc Fam Pract. 2019 Nov 1; 20 (1): 149149.

BackgroundCardiovascular diseases (CVD) contribute considerably to mortality and morbidity. Prevention of CVD by lifestyle change and medication is important and needs full attention. In the Netherlands an integrated programme for cardiovascular risk management (CVRM), based on the Chronic Care Model (CCM), has been introduced in primary care in many regions in recent years, but its effects are unknown. In the ZWOT-CASE study we will assess the effect of integrated care for CVRM in the region of Zwolle on two major cardiovascular risk factors: systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-cholesterol) in patients with or at high risk of CVD.MethodsThis study is a pragmatic observational study comparing integrated care for CVRM with usual care among patients aged 40-80 years with CVD (n = 370) or with a high CVD risk (n = 370) within 26 general practices. After 1 yr follow-up, primary outcomes (SBP and LDL-cholesterol level) are measured. Secondary outcomes include lifestyle habits (smoking, dietary habits, alcohol use, physical activity), risk factor awareness, 10-year risk of cardiovascular morbidity or mortality, health care consumption, patient satisfaction and quality of life.ConclusionThe ZWOT-CASE study will provide insight in the effects of integrated care for CVRM in general practice in patients with CVD or at high CVD risk.Trial RegistrationThe ZWOlle Transmural Integrated Care for CArdiovaScular Risk Management Study; ClinicalTrials.gov ; Identifier: NCT03428061; date of registration: 09-02-2018; This study has been retrospectively registered.

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