How general practitioners perceive and grade the cardiovascular risk of their patients.
ABSTRACT Although risk assessment charts have been proposed to identify patients at high cardiovascular risk, in everyday practice general practitioners (GPs) often use their knowledge of the patients to estimate the risk subjectively.
A cross-sectional study aimed to describe how GPs perceive, qualify and grade cardiovascular risk in everyday practice.
General practitioners had to identify in a random sample of 10% of their contacts the first 20 consecutive patients perceived as being at cardiovascular risk. For each patient essential data were collected on clinical history, physical examination and laboratory tests, for the qualification of risk. At the end of the process GPs subjectively estimated the overall patient's level of risk. General practitioners grading was compared with the risk estimate from a reference chart.
Over a mean time of 25 days 3120 patients perceived as being at cardiovascular risk were enrolled. According to the inclusion scheme each GP had contact with more than 200 patients at cardiovascular risk every month. Thirty percent of these patients had atherosclerotic diseases. Up to 72% of patients without any history of atherosclerotic diseases but perceived to be at risk could be classified according to a reference chart as being at moderate to very high risk. Comparing GPs' grading of risk with a chart estimate there was agreement in 42% of the cases. Major determinants of GPs' underestimation of risk were age, sex and smoking habits, while obesity and family history were independently associated with overestimation.
On the basis of their perception GPs properly identify patients at cardiovascular risk in the majority of cases. General practitioners subjective grading of risk level only partially agreed with that given by a chart.
- SourceAvailable from: Roberto Marchioli
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- "Another possible limit is the unusual way of defining the level of cardiovascular risk. We preferred to classify the patients' risk according to the GPs' perception because in a previous analysis we had found these estimates were not only associated with the patients' level of risk but were also independent of the levels of single risk factors, such as BP or blood cholesterol (Roncaglioni et al 2004). The use of algorithms or charts would have favored the inclusion of uncontrolled hypertensive and hyperlipidemic patients in the high or very high risk categories. "
ABSTRACT: To assess the pharmacological treatment and the control of major modifiable cardiovascular risk factors in everyday practice according to the patients' cardiovascular risk level. In a cross-sectional study general practitioners (GPs) had to identify a random sample of their patients with cardiovascular risk factors or diseases and collect essential data on the pharmacological treatment and control of hypertension, hyperlipidemia, and diabetes according to the patients' cardiovascular risk level and history of cardiovascular disease. Participants were subjects of both sexes, aged 40-80 years, with at least one known cardiovascular risk factor or a history of cardiovascular diseases. From June to December 2000, 162 Italian GPs enrolled 3120 of their patients (2470 hypertensives, 1373 hyperlipidemics, and 604 diabetics). Despite the positive association between the perceived level of global cardiovascular risk and lipid-lowering drug prescriptions in hyperlipidemic subjects (from 26% for lowest risk to 56% for highest risk p < 0.0001) or the prescription of combination therapy in hypertensives (from 41% to 70%, p < 0.0001) and diabetics (from 24% to 43%, p = 0.057), control was still inadequate in 48% of diabetics, 77% of hypertensives, and 85% of hyperlipidemics, with no increase in patients at highest risk. Trends for treatment and control were similar in patients with cardiovascular diseases. Even in high-risk patients, despite a tendency towards more intensive treatment, pharmacological therapy is still under used and the degree of control of blood pressure, cholesterol level and diabetes is largely unsatisfactory.Vascular Health and Risk Management 12/2006; 2(4):507-14. DOI:10.2147/vhrm.2006.2.4.507
- MRS Online Proceeding Library 01/2003; 797. DOI:10.1109/CLEO.2003.1298093
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ABSTRACT: We propose a framework for Snort network-based intrusion detection system to make it have the ability of not only catching new attack patterns automatically, but also detecting sequential attack behaviors. To do that, we first build an intrusion pattern discovery module to find single intrusion patterns and sequential intrusion patterns from a collection of attack packets in offline training phase. The module applies data mining technique to extract descriptive attack signatures from large stores of packets, and then it converts the signatures to Snort detection rules for online detection. In order to detect sequential intrusion behavior, the Snort detection engine is accompanied with our intrusion behavior detection engine. When a series of incoming packets match the signatures representing sequential intrusion scenarios, intrusion behavior detection engine make an alert.Security Technology, 2003. Proceedings. IEEE 37th Annual 2003 International Carnahan Conference on; 11/2003