New CVS clinical improvement project improves screening for hypertension in older cats
CVS has conducted a new clinical improvement project in 105 of its first opinion small animal practices to increase screening for hypertension in older cats.
Within 12 months, it has led participating practices to more than double (110%) the number of blood pressure checks they have conducted with these patients.
Hypertension has a prevalence of 10% in healthy dogs and up to 40% in healthy cats over seven years old[i]. Prevalence increases up to 80% in patients with Chronic Kidney Disease (CKD)[ii].
Hypertension is best identified at the earliest opportunity, improving survival and prevent long-lasting damage[iii]. Routine screening is recommended in a wide number of circumstances (see Figure 1). International Society of Feline Medicine Guidelines recommend that, from the age of seven, cats would benefit from an annual blood pressure check.
Undiagnosed hypertension can lead to serious disorders affecting the eyes, brain, heart and kidneys, leading to sudden onset blindness, and is a risk factor for kidney disease and heart disease. However, if diagnosed early, simple medications can be initiated to allow optimal outcomes for each patient.
The CVS’ clinical improvement project initially looked at how effective its first opinion small animal practices were in screening older cats for hypertension. In line with the veterinary industry norm[iv], it found that less than two per cent of cats over the age of seven were receiving an annual blood pressure check. This initial research also found that the common barriers to conducting blood pressure checks by vets and veterinary nurses in practice were due to time constraints, availability of equipment and simply remembering (and having confidence) to discuss this with owners.
Each CVS site chose two people to lead this focus at their site, to aid communication and delivery. A document was created to help, providing background, aims, summary of resources and planning sections. Contributory factors preventing delivery of best care were outlined; crucially, practices were encouraged to identify additional barriers and resources needed.
A suite of resources were produced to support the whole practice team – from reception colleagues to veterinary surgeons – in improving annual blood pressure check rates. This included new clinical frameworks and veterinary guidelines on how to treat hypertension; in-practice educational resources[v] to highlight the benefits of hypertension screening, and information sheets and blood pressure diaries to help clients manage their pet's condition.
To upskill and develop colleagues in how to identify and treat hypertension and resulting conditions, a collection of training materials was created and training sessions were held[vi]. These include a series of webinars comprising of why hypertension is important to identify, how to overcome common challenges encountered when looking for hypertension in cats, how to utilise the ophthalmic exam to help diagnose hypertension, and how to treat hypertension. Three (free of charge) in-person CPD days were hosted, with the support from Ceva, six months into the focus. Feline specialists Sarah Caney and Samantha Taylor shared the latest evidence base in this field, and practices were encouraged to share barriers, queries and tips, so that ideas could be taken away to make blood pressure screening a simpler process in practice. Practices were also encouraged to organise lunch and learn CPD sessions, to share best practice and generate discussion within their entire team.
In addition, a website hosted all resources in one place, including webinars, clinical frameworks, client resources, a discussion forum and data.
An audit of each participating practice’s blood pressure check data was conducted at the start of the project. Results were then shared with each participating practice every month – including the total number of blood pressure checks performed each month and the percentage of cats over the age of seven who had an annual blood pressure check.
Twelve months after its nation-wide launch, results reveal that the number of blood pressure checks have more than doubled (110%) within participating CVS practices; an additional 5,984 blood pressures have been performed year on year. A number of practices were able to implement systems that allowed them to perform over 40 blood pressures each month. The number of cats on Amlodipine (the first choice medication to treat hypertension in cats) increased by 303 patients year-on-year, hinting that many more cats had been diagnosed with hypertension.
Kate Allgood, Hub Clinical Lead at CVS who was responsible for the hypertension clinical improvement project, said:
“There is a huge benefit in treating hypertension. No one wants to see a cat suddenly become blind due to hypertension that wasn’t recognised in time. So many associated longer-term feline complications and conditions can be avoided if annual blood pressure checks in cats over the age of seven are routinely performed. Increasing blood pressure screening is not a simple task though, and this focus has allowed space and time for practices to give this topic the recognition it deserves; to identify and implement systems that make it easier to identify patients at risk, discuss with clients and perform these checks with ease. We have created a robust clinical structure, produced some easily accessible materials and supported our practices to make small and simple changes that add up. Our practices have done an outstanding job at delivering this project to date and I look forward to seeing what can be achieved in the future. We strongly believe that this work will contribute towards providing some of the best clinical care for cats in the veterinary profession.”
CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with over 500 veterinary practices and referral centres in the UK, the Republic of Ireland and the Netherlands. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals.
[i] Remillard, R.; Ross, J. and Eddy, J. (1991). ‘Variance of indirect blood pressure measurements and prevalence of hypertension in clinically normal dogs.’ American Journal of Veterinary Research; [online] 52: 561-565 [Accessed 17th March 2023].
[ii] Acierno, M.; Brown, S.; Coleman, A.; Jepson, R.; Papich, M.; Stepien, R. and Syme, H. (2018). ‘ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats.’ Journal of Veterinary Internal Medicine, [online] 32(6), pp. 1803-1822. DOI: 10.1111/jvim.15331 [Accessed 17th March 2023].
[iii] Conroy, M.; Chang, Y.; Brodbelt, D. and Elliott, J. (2018). ‘Survival after diagnosis of hypertension in cats attending primary care practice in the United Kingdom.’ Journal of Veterinary Internal Medicine, [online] 32(6), pp. 1846-1855. DOI:10.1111/jvim.15307 [Accessed 17th March 2023]
Caney, S. (2021) ‘Feline blood pressure measurement: when is it needed?’ Companion Animal. [online], 26 (11), pp. 222-228. DOI: 10.12968/coan.2021.0063. [Accessed 18th March 2023].
Caney, S. (2009) ‘Hypertension’, in Harvey, A. and tasker, S. (eds) BSAVA Manual of Feline Practice A Foundation Manual. Gloucester, UK: British Small Animal Veterinary Association, pp. 238-243.
[iv] Dhaliwal, R.; Boynton, E.; Carrera-Justiz, S.; Cruise, N.; Gardner, M.; Huntingford, J.; Lobprise, H. and Rozanski, E. (2023) ‘2023 AAHA Senior Care Guidelines for Dogs and Cats.’ Journal of American Animal Hospital Association. [online] 59, pp. 1-21. DOI: 10.5326/JAAHA-MS-7343 [Accessed 17th March 2023].
[v]Quimby, J.; Gowland, S.; Carney, H. DePorter, T.; Plummer, P. and Westropp, J. (2021) ‘2021 AAHA/AAFP Feline Life Stage Guidelines.’ Journal of Feline Medicine and Surgery. [online] 23, pp. 211-233. DOI: 10.1177/1098612X21993657 [Accessed 17th March 2023].
Ray, M.; Carney, H.; Boynton, B.; Quimby, J.; Robertson, S.; St Denis, K.; Tuzio, H. and Wright, B. (2021) ’2021 AAFP Feline Senior Care Guidelines.’ Journal of Feline Medicine and Surgery. [online] 23, pp. 613-638. DOI: 10.1177/1098612X211021538 [Accessed 17th March 2023].