OBJECTIVE: To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care. DESIGN, SETTING AND PARTICIPANTS: 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 >or= 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. MAIN OUTCOME MEASURES: Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment. RESULTS: Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (>or= 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 (Kappa = 0.21). CONCLUSIONS: 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.
AD - The George Institute for International Health, Sydney, NSW, Australia. eheeley@george.org.au AN - 20201758 BT - Medical Journal of Australia ET - 2010/03/06 LA - eng M1 - 5 N1 - Heeley, Emma LPeiris, David PPatel, Anushka ACass, AlanWeekes, AndrewMorgan, ClaireAnderson, Craig SChalmers, John PResearch Support, Non-U.S. Gov'tAustraliaThe Medical journal of AustraliaMed J Aust. 2010 Mar 1;192(5):254-9. N2 -OBJECTIVE: To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care. DESIGN, SETTING AND PARTICIPANTS: 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 >or= 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. MAIN OUTCOME MEASURES: Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment. RESULTS: Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (>or= 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 (Kappa = 0.21). CONCLUSIONS: 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.
PY - 2010 SN - 0025-729X (Print)0025-729X (Linking) SP - 254 EP - 9 T2 - Medical Journal of Australia TI - Cardiovascular risk perception and evidence--practice gaps in Australian general practice (the AusHEART study) VL - 192 ER -