Doctors fall short on heart disease prevention
NEW YORK (Reuters Health) - Some doctors are not making the grade when it comes to helping their patients ward off heart disease, a new survey suggests.
The survey, of nearly 900 U.S. primary care doctors, found that many do not follow practice guidelines on managing patients who are at elevated risk of heart and blood vessel disease.
"Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations," conclude researchers in a report in the journal BMC Family Practice.
"Patients should talk to their physicians about setting goals together for reducing blood pressure and cholesterol and making a plan to achieve the goals," lead researcher Dr. Hamidreza Doroodchi, from Birmingham, Alabama-based Outcomes, Inc., noted in comments to Reuters Health.
Doroodchi and colleagues sent a survey on cardiovascular disease management to a random sample of 12,000 U.S. family physicians and general internists. A total of 888 completed the survey, which contained "case vignettes" for managing adults deemed to be at low or high risk of heart disease.
The study found that in the hypothetical case of a low-risk 45-year-old woman, only 28 percent of family doctors and 37 percent of internists made the "guideline-based preventive choice" of prescribing no aspirin or other antiplatelet therapy -- drugs that help prevent blood clots by keeping platelet blood cells from clumping together. The majority indicated that they would prescribe a daily aspirin for such a patient to reduce the risk of heart attack.
When asked whether they would start drug therapy to combat abnormal cholesterol levels, 51 percent of doctors said they would not do so in this low-risk patient -- which is in accordance with guidelines. On the other hand, 41 percent said they would prescribe a statin.
When it came to basic lifestyle advice, which is appropriate for low- and high-risk patients alike, doctors often fell short.
For example, while experts recommend that all adults limit their intake of artery-clogging trans fats, over one-third of doctors in the survey failed to recommend this measure for the low-risk 45-year-old woman.
For a 50-year-old man at high risk for heart disease, only 59 percent of family doctors and 56 percent of internists correctly identified the guideline-based goal of keeping "bad" LDL cholesterol below 100 milligrams per deciliter.
Similarly, for a 78-year-old woman at high risk for heart disease but no obvious symptoms, only about half of family doctors and internists were in accordance with guidelines to order a stress test should she develop chest pain or shortness of breath.
Doctors in practice for 10 years or less were much more likely than doctors in practice for more than 10 years to make appropriate guideline-based choices for the prevention of heart disease. Younger doctors were also more apt to adhere to guidelines than were more experienced doctors.
Doroodchi and colleagues found it "especially concerning" that doctors who see a greater percentage of patients with high blood pressure and cholesterol abnormalities were significantly less likely to offer guideline-based care.
"Innovative educational approaches," they conclude, "are needed to address barriers, and target specific groups of physicians to facilitate implementation of guideline-based recommendations for cardiovascular management."
The findings should not, however, be taken as a sign that doctors lack concern for their patients, according to Doroodchi.
"Most primary care physicians are concerned about cardiovascular risk in their patients and set goals for their patients to reduce this risk," the researcher said. "Physicians are concerned that their patients do not follow their advice about changes in exercise and diet, and (that) they do not always take the medicine that is prescribed."
SOURCE: BMC Family Practice, July 8, 2008.
