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Med J Aust. 2010 Mar 1;192(5):254-9.

Cardiovascular risk perception and evidence--practice gaps in Australian general practice (the AusHEART study).

Author information

1
The George Institute for International Health, Sydney, NSW, Australia. eheeley@george.org.au

Abstract

OBJECTIVE:

To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care.

DESIGN, SETTING AND PARTICIPANTS:

The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey of 322 general practitioners. Each GP was asked to collect data on CVD risk factors and their management in 15-20 consecutive patients aged >or= 55 years who presented between April and June 2008, and to estimate each patient's absolute risk of a cardiovascular event in the next 5 years.

MAIN OUTCOME MEASURES:

Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment.

RESULTS:

Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (>or= 15%) 5-year risk of a cardiovascular event. Of the 1548 patients with established CVD, 50% were prescribed a combination of a blood pressure (BP)-lowering medication, a statin and an antiplatelet agent, and 9% were prescribed a BP-lowering medication and a statin but not an antiplatelet agent. Among high-risk patients without established CVD, categorised using NHF 2004 adjustments, 34% were prescribed a combination of a BP-lowering medication and a statin. GPs estimated 60% of patients with established CVD as having a risk of less than 15%. The GPs' estimates of risk among patients without established CVD agreed with the centrally calculated estimate (according to the NHF 2004 guideline) in 48% of instances (Kappa = 0.21).

CONCLUSIONS:

These data confirm substantial undertreatment of patients who are at high risk of a cardiovascular event. We recommend that GPs assess absolute risk for older patients and ensure that high-risk patients receive evidence-based pharmacotherapy.

PMID:
20201758
[Indexed for MEDLINE]

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