High-Risk Cardiovascular Patients Undertreated in General Practice

Patients who are at high risk of a cardiovascular event are substantially undertreated, according to the authors of a study published in the Medical Journal of Australia.

Dr Emma Heeley, Senior Research Fellow at the George Institute for International Health, and her co-authors conducted a nationally representative, cross-sectional survey of 322 GPs, who were asked to collect data on cardiovascular disease (CVD) risk factors and their management in 15-20 consecutive patients aged 55 years and over.

Their study found low uptake of absolute risk-based care in general practice, with just 63 per cent of GPs reporting using CVD risk calculators. There were also substantial differences between patients’ CVD risks as perceived by GPs and when calculated using Framingham risk equations and different guideline adjustments, leading GPs to underestimate their patients’ absolute risks.

“The AusHEART study shows that large evidence-practice gaps exist in primary and secondary prevention of CVD for older Australians,” Dr Heeley said.

Of the 1548 patients with established CVD, only half were prescribed a combination of a blood pressure-lowering medication, a statin and an antiplatelet agent, despite evidence for the benefit of this combination of therapy being well established in this group, Dr Heeley said.

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“When stratified by absolute risk category, around two-thirds of patients at high risk of a first CVD event were not prescribed a combination of a BP-lowering medication and a statin,” she said.

Dr Heeley said the findings were not only related to individual clinicians; they were also attributable to system failure.

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“Because around 85 per cent of Australians visit a general practitioner every year, primary care is the ideal setting for CVD prevention … A stronger effort to rationalise the many guidelines for assessment and management of CVD risk factors is needed, accompanied by simple tools to help general practitioners implement them,” Dr Heeley said.

“Harmonisation of guidelines with the PBS is a key accompanying step.”

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“This survey highlighted that most patients aged 55 or older who attend GPs are at high risk of CVD,” Dr Heeley said. “We recommend that GPs assess the absolute CVD risk of their older patients and ensure that high-risk patients receive evidence-based pharmacotherapy.”

The Medical Journal of Australia is a publication of the Australian Medical Association.

Source-MJA
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