Gaps in cardiovascular disease risk management in Australian general practice

Abstract

Objective: To evaluate the management of cardiovascular disease (CVD) risk in Australian general practice. Design, setting and participants: National cross‐sectional survey of 99 Australian general practitioners participating in the Bettering the Evaluation and Care of Health (BEACH) program. Data on 2618 consecutive adult patients presenting to the participating GPs over a 5‐week period from September to October 2006 were analysed. Main outcome measures: Proportions of patients screened, treated and reaching targets according to (1) current Australian CVD risk guidelines and (2) overall or absolute CVD risk. Results: Blood pressure (BP) had not been recorded for 13% of the sample. Of 1400 patients not prescribed antihypertensive medication, treatment was indicated for 8%. Of 821 patients already prescribed antihypertensive medication, 59% were achieving target BPs. Data on low‐density lipoprotein (LDL) cholesterol levels were not available for 53% of the 2175 patients who should have had lipid screening according to the guidelines. Of 624 patients not prescribed a statin, treatment was indicated for 41%. Of 368 already prescribed a statin, 62% were achieving target LDL cholesterol levels. Sufficient data for calculation of absolute risk had been recorded for 74% of the 1736 patients for whom such calculation was recommended by the guidelines. The remaining 26% either had at least one required variable unmeasured (20%) or missing from the data collection (6%). For those at high absolute CVD risk (without established disease) and those with established CVD, 23% and 53%, respectively, had been prescribed both antihypertensive medication and a statin. Conclusions: Gaps between guideline recommendations and practice in recording and managing BP were relatively low compared with gaps for lipids. When stratified by absolute risk, patients at high risk of a cardiovascular event were found to be substantially undertreated.

Use of Aspirin and Statin as primary prevention for cardiovascular diseases

“…Other researchers have reported similar gaps in the management of cardiovascular risk. While aspirin is frequently used by millions of patients worldwide, especially for primary prevention of CVD, many patients with established CVD are not using aspirin 6. In another report,7 it was found that statin treatment was not prescribed for 41% of diabetic patients at high risk for cardiovascular events.…”

General practitioners’ use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study

“…Past research includes studies exploring barriers to GPs’ use of absolute risk19–22 and studies quantifying treatment gaps using clinical databases12 16 17 23 24 but individual decision-making about absolute risk has not been comprehensively examined quantitatively. In this study we applied a method based on judgements of hypothetical patient cases to analyse GPs’ decisions about CVD risk management and their use of absolute risk.…”

Perceptions of risk: understanding cardiovascular disease

“…Diet and exercise,11–13 smoking cessation,14,15 statin therapy,16 blood-pressure-lowering medication,17 and antiplatelet medications18 have all shown clear benefit in lowering CV risk. Despite there being a clear understanding of how to measure and subsequently modify CV risk, risk factors are highly prevalent in the general population19 and those who are indicated for pharmacological treatment are not necessarily receiving it 20–22. Within the broad range of factors that affect uptake of information and implementation of change, it is important to consider the role of doctors and patients in the perception of CV risk.…”