Evidence–practice gaps in general practice re cardiovascular risk

January 01, 0001

Evidence-practice gaps in general practice re cardiovascular risk

The aim of this study by researchers from Australia was to examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care. The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey of 322 general practitioners. Each GP was asked to collect data on CVD risk factors and their management in 15-20 consecutive patients aged = 55 years who presented between April and June 2008, and to estimate each patient’s absolute risk of a cardiovascular event in the next 5 years.

Among 5293 patients, 29% had established CVD. A further 22%, when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42%, when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (15%) 5-year risk of a cardiovascular event. Of the 1548 patients with established CVD, 50% were prescribed a combination of a blood pressure (BP)-lowering medication, a statin and an antiplatelet agent, and 9% were prescribed a BP-lowering medication and a statin but not an antiplatelet agent. Among high-risk patients without established CVD, categorised using NHF 2004 adjustments, 34% were prescribed a combination of a BP-lowering medication and a statin. GPs estimated 60% of patients with established CVD as having a risk of less than 15%. The GPs’ estimates of risk among patients without established CVD agreed with the centrally calculated estimate (according to the NHF 2004 guideline) in 48% of instances (not significant).

The researchers concluded: "These data confirm substantial undertreatment of patients who are at high risk of a cardiovascular event. We recommend that GPs assess absolute risk for older patients and ensure that high- risk patients receive evidence-based pharmacotherapy."

The insurers (including some governments) will only like to hear this if such increased pharmacotherapy (and other interventions to reach targets) is eventually overall cost-effective.

For the full abstract, click here.

MJA 192(5): 254-259, 2 March 2010 © The Medical Journal of Australia 2010
Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). Emma L Heeley, David P Peiris, Anushka A Patel, Alan Cass, Andrew Weekes, Claire Morgan, Craig S Anderson and John P Chalmers. Correspondence to Emma Heeley: [email protected]

Category: K. Circulatory, HSR. Health Services Research. Keywords: risk, cardiovascular, perception, evidence, practice, gaps, general practice, Australia, cross sectional survey, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 March 2010

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