Strengthening the quality of care for hypertension, cardiovascular disease (CVD), and type 2 diabetes is a strategic priority for primary care. To guide continuous quality improvement and support national PHC reforms, a multi-year clinical audit at the National Family Medicine Training Center in Georgia (Serving 29000 population) evaluated trends in service quality between 2019 and 2023.A structured clinical audit reviewed 648 records from routine primary care visits in 2023 and compared them with assessments conducted in 2019. Indicators reflected core process and outcome measures, including  diagnostic testing, cardiovascular risk assessment, and adherence to evidence-based treatment.Between 2019 and 2023, smoking status documentation rose from 61% to 86%. Fasting glucose testing increased, from 27.7% to 77.6% in the general population, while cholesterol testing rose from 18.5% to 85.7%, and LDL testing from 3.6% to 39.4%. BMI recording improved from 45% to 77%. Among people with diabetes, HbA1c testing doubled (16.6% to 34.3%), fasting glucose testing reached 91.1%, and statin prescribing increased from 33.4% to 72.8%.  Despite these gains, several gaps persisted. Blood pressure control among the general population declined from 83% to 47%, likely driven by limited health-seeking behavior during Covid-19 pandemic. Screening for diabetes complications remained minimal, including microalbuminuria testing, assessments of peripheral pulses, neuropathy checks, and foot examinations. Significant variability across PHC teams also pointed to uneven implementation of guidelines.Improved measurement, preventive activities, and evidence-based prescribing demonstrate meaningful progress in primary care quality. However, weaker performance in BP control, limited complication screening, and variation among teams highlight areas requiring systemic strengthening, workflow redesign, and targeted training.Quality of NCD management in primary care improved substantially between 2019 and 2023. Further progress will depend on standardizing practice across teams, integrating systematic complication screening, and enhancing risk-based management.

Atherosclerotic peripheral arterial disease (PAD) of the lower limbs is a prevalent condition and a strong marker of cardiovascular risk, affecting an estimated 236 million people worldwide. Cardiovascular mortality ranges from 9% in asymptomatic to 13% in symptomatic patients. The European Society of Cardiology (ESC) recommends LDL-C < 55 mg/dL with >50% reduction from baseline, alongside appropriate antiplatelet or dual antithrombotic therapy.To optimize lipid-lowering and antithrombotic therapy in lower-limb PAD according to the 2024 ESC guidelines, and to improve clinical record quality by correcting PAD (ICPC2-K92) miscoding and reinforcing diagnostic and therapeutic review within the medical team.A retrospective quality-improvement study was conducted over six months, including patients with atherosclerotic lower-limb PAD and LDL-C > 55 mg/dL and/or non-compliant antithrombotic therapy according to ESC 2024 guidelines. A clinical meeting was held to review cases and implement corrective strategies. Target achievement rates were classified as ≥50% (desirable) and ≥70% (excellent).A total of 231 patients coded with K92 (ICPC2 - Atherosclerosis/Peripheral Arterial Disease) were analysed. After applying exclusion criteria, 137 records were removed, resulting in a final sample of 94 patients. Seventy patients (74.5%) were identified as eligible, either because they had not achieved LDL-C targets, were not receiving appropriate antithrombotic therapy, or both. After the improvement cycle, 37 patients (52.9%) met the therapeutic goals. Of the remaining patients, 13 (18.6%) did not respond to the recall, and 20 (28.6%) did not reach the targets.The improvement cycle revealed ongoing challenges in PAD management, notably in accurate clinical coding and adherence to guideline-recommended therapy. Suboptimal LDL-C control was often associated with socioeconomic barriers, limited health literacy, and competing priorities in primary care. These results highlight the need for sustained, systematic approaches to ensure consistent, evidence-based management of PAD.This project underscores the importance of optimizing pharmacological treatment in lower-limb PAD, a highly prevalent condition with very high cardiovascular risk. While achieving a desirable improvement, according to predefined criteria, the fact that 47.1% of patients remained outside therapeutic targets demonstrates the need for strengthened intervention strategies and closer follow-up.

Abdominal Aortic Aneurysm (AAA) screening is a nationally implemented programme in England aimed at reducing aneurysm-related mortality through early detection. Primary care plays a crucial role in promoting screening, clarifying eligibility, and supporting patient engagement. Little is known about healthcare professionals’ (HCPs) understanding, confidence, and learning needs relating to the AAA screening pathway.To assess primary care HCPs’ awareness of AAA screening, explore perceived barriers within practice systems, evaluate confidence in supporting patients, and identify key educational needs to strengthen primary care involvement.A mixed-methods questionnaire was distributed electronically to primary care professionals in a rural setting. Quantitative items assessed familiarity, role clarity, system reliability, and confidence, while qualitative free-text responses underwent inductive thematic analysis. Data were integrated to produce a comprehensive analysis of learning needs and perceived barriers.Nineteen HCPs participated. Awareness of the national screening programme was low: 87% reported being only vaguely familiar or not familiar at all, and none were “very familiar”. Misconceptions were evident: 36% believed that women aged 65 receive routine invitations. Confidence was limited; 92% were unclear about the pathway for men over 65 who missed screening, and 100% lacked clarity regarding their follow‑up responsibilities. Over half were not confident or unsure in arranging screening requests. Systems for identifying eligible men were inconsistent, with 69% uncertain whether their practice’s recall processes were reliable. Key barriers included lack of system prompts (82%), limited pathway awareness (73%), time pressures (64%), and unclear responsibility between primary care and the screening programme (55%). Educational needs were substantial: 91% reported high or very high need for further training. Priority topics included eligibility and national guidance (91%), explaining screening to patients (82%), risk factors (64%), local pathways (64%), and surveillance intervals (55%). Preferred formats included face‑to‑face teaching (36%), webinars (27%), and written guides (18%).Findings reveal significant gaps in HCP familiarity, confidence, and clarity regarding AAA screening, as well as substantial system-level barriers. Enhanced training and improved digital prompts could strengthen primary care engagement.Education, clarification of pathways, optimisation of digital systems, and integration of screening prompts could substantially improve HCP confidence and support patient uptake of AAA screening.

Abdominal Aortic Aneurysm (AAA) screening is an established national programme in England aimed at reducing aneurysm-related mortality through early detection. However, uptake varies substantially and is affected by awareness, accessibility, and understanding of the screening process. Primary care plays a central role in supporting engagement, yet patient perspectives remain underexplored.To assess patient awareness, understanding, motivations, barriers, and willingness to attend AAA screening, and to identify opportunities for improvement in primary care-led promotion and support of screening attendance.A mixed-methods questionnaire was distributed electronically to adults within a rural primary care population. Quantitative data were analysed descriptively, and free-text responses were analysed thematically using an inductive approach. Responses were integrated to produce a comprehensive assessment of patient experience, perceptions, and screening intentions.Of 514 respondents, 94.4% consented to participate. Most were aged 65–74 (60%) or over 75 (33%), with an even gender distribution. Awareness was low: 68% reported never having heard of AAA screening, and only 18.5% recalled receiving an invitation. Knowledge gaps were substantial: 62% did not know screening is routinely offered to men aged 65, and 74% were unaware that men over 65 may self-refer. Despite this, willingness to attend was high, with 86.6% reporting they would be “very likely” or “likely” to attend. Key motivators included identifying problems early (83%), looking after personal health (76%), clear information (62%), and local venues (70%). Primary barriers were logistical: distance to the clinic (51%), transport difficulties (20%), late appointment letters (34%), and limited appointment flexibility (23%). Qualitative data reinforced themes of poor awareness, confusion around eligibility, transport difficulties, and “fear of the unknown”. Prior attenders reported universally positive experiences.Findings indicate that low awareness rather than reluctance is the predominant barrier to uptake. Accessibility and communication gaps further limit engagement. Primary care is well-positioned to address these shortcomings through personalised invitations, SMS reminders, local delivery models, and clear, consistent patient education.Enhancing communication, improving local access, clarifying eligibility, and using multimodal reminders could significantly improve AAA screening attendance and reduce preventable morbidity and mortality in primary care populations.

We investigate the impact of weight variability  on the cardiovascular disease (CVD) outcomes among elderly individuals aged 75 years and older in Korea, utilizing the National Health Insurance Service (NHIS) Big DataBody weight variability (BWV) has emerged as an important marker of adverse clinical outcomes, yet most prior studies have focused on middle-aged adults or the general elderly population. Given the substantial cardiovascular burden in adults aged 75 years or older, we aimed to evaluate the association between BWV and cardiovascular outcomes in this age group.We used a database of the Korean National Health Insurance system, and a total of 432,904 older adults aged 75 years or older who underwent health check-ups between 2012 and 2015 were included. BWV was defined as variability independent of the mean with the body weight measured at the check-ups. The study outcome was major adverse cardiovascular events (MACE), including myocardial infarction (MI), stroke, and cardiovascular (CV) mortality. We used Cox regression models to estimate the effect of BWV on MACEs.The individuals were followed for an average of 6.79 ± 2.42 years, during which 76,678 MACEs were occurred among the 432,904 individuals. Compared to individuals within the lowest quartile (Q1) of BWV, those with the highest quartile (Q4) was associated with an increased risk of MACEs (hazard ratio, HR 1.26, 95% confidence interval, CI 1.24–1.29), MI (HR 1.19, 95% CI 1.15–1.24), stroke (HR 1.16, 95% CI 1.13–1.19), and CV mortality (HR 1.51, 95% CI 1.51–1.57). These results remained consistent after adjusting for baseline body weight as a confounding variable.Globally, the elderly population is increasing, with a particularly sharp rise in the oldest-old population. We can observe that in this demographic, similar to other age groups, greater weight variability is associated with an increased prevalence and mortality from cardiovascular diseases.Higher BWV was significantly associated with an increased risk of MACEs among adults aged 75 years or older, independent of baseline body weight. These findings highlight the importance of maintaining weight stability as a potential strategy to reduce cardiovascular risk in the oldest-old population

Stroke remains a leading cause of mortality and long-term disability worldwide. Most strokes are linked to modifiable cardiovascular risk factors and early prodromal or warning symptoms frequently go unrecognized leading to missed opportunities for prevention and timely intervention in general practice.The primary objective of this study was to assess the presence of potential warning signs occurring within the four weeks preceding an ischaemic stroke. A secondary objective was to analyse the management of major cardiovascular risk factors (hypertension, diabetes, smoking and dyslipidaemia) by general practitioners during the twelve months before stroke onset.This quantitative, observational, non-interventional, single-centre study was conducted in XXX over a six months period. Inclusion criteria comprised age of 18 years or older, a confirmed diagnosis of ischaemic stroke and at least one consultation with a general practitioner within the previous year. Patients were recruited in the Neurovascular Unit of the XXX Hospital. Data were collected during structured patient interviews and from electronic medical records.Ten participants were included (mean age: 66 years; 70% men) of whom nine reported at least one neurological or non-neurological warning symptom within the four weeks preceding stroke onset. No significant increase in consultation frequency with general practitioners was identified. All patients presented at least two modifiable cardiovascular risk factors: smoking (6 out of 10 participants) hypertension (5/10), dyslipidaemia (5/10), and diabetes or prediabetes (4/10). Lifestyle factors were also prevalent, including low physical activity (7/10), alcohol consumption (5/10), and psychosocial stress (6/10). Overall, management of cardiovascular risk factors appeared suboptimal.These findings suggest that many strokes may be preceded by subtle prodromal symptoms that are often overlooked. Enhanced awareness among general practitioners and patients could improve early recognition and risk factor control.This study, the first of its kind, demonstrates that ischaemic stroke may not be as sudden as previously thought. The early recognition of these subtle warning signs by general practitioners, combined with improved management of risk factors, could enhance stroke prevention efforts.