How general pratitioners perceive and grade the cardiovascular risk of their patients

Mario Negri Institute of Pharmacological Research, Via Eritrea 62, 20158 Milan, Italy.
European Journal of Cardiovascular Prevention and Rehabilitation (Impact Factor: 3.69). 07/2004; 11(3):233-8. DOI: 10.1097/01.hjr.0000129737.84851.99
Source: PubMed


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.

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    • "In this context, therefore, besides an objective and subjective investigation of the health of the elderly, it is essential to analyze their real health needs and the response to these needs, especially in terms of healthcare, that the territorial services are perceived to offer [17]. In the present study, this assessment has been made by comparing the subjective experience of patients over 65 years of age with that of their General Practioner (GP), who takes the main role in primary health care of elderly, in Italy [18-21]. "
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    ABSTRACT: In recent decades in Italy, as in all the industrialized nations, the proportion of elderly subjects in the total population is constantly on the increase. However the increased life expectancy is not always paralleled by a true improvement in the quality of life. In this context, it is essential to analyze elderly real health needs and the responses to these needs, especially in terms of healthcare, that the territorial services are perceived to offer. In the period from June to September 2006 we selected randomly one General Practitioner (GP) for each district of the Bari Municipal Area and, form each GP, we randomly chose 25 patients over 65 years old (YO). We conducted phone interviews using a standard data collection questionnaire and, for each of the recruited subjects, the GP filled a data collection sheet. Although the mean age (73.6 years) of the population under study was quite high, the general state of health was judged good both by the G P- and by their elderly patients (>75%).Notably, the great majority of elderly patients considered the healthcare they receive to be satisfactory (>60%): in particular, the GP was the true point of reference for this slice of the population for strictly medical problems as well as for advice. On the contrary, the patients attributed little value to social services, which were poorly known and scarcely used (8.5%). Public hospital facilities played a central role in second level healthcare in more than 30% of cases; private facilities covered by public health insurance were also very important. As possible solutions to the problem of loneliness, 36.6% of the patients declared that they approved of nursing homes. Decision makers need to create services supporting the key role played by General Practitioners, who are well aware that their assistance is not sufficient to satisfy the health needs of the elderly.
    Full-text · Article · Oct 2007 · BMC Health Services Research
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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. "
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    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.
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