Abstract
BackgroundGlobal coronary heart disease (CHD) risk assessment is recommended to guide primary preventive pharmacotherapy. However, little is known about physicians' understanding and use of global CHD risk assessment. Our objective was to examine US physicians' awareness, use, and attitudes regarding global CHD risk assessment in clinical practice, and how these vary by provider specialty.MethodsUsing a web-based survey of US family physicians, general internists, and cardiologists, we examined awareness of tools available to calculate CHD risk, method and use of CHD risk assessment, attitudes towards CHD risk assessment, and frequency of using CHD risk assessment to guide recommendations of aspirin, lipid-lowering and blood pressure (BP) lowering therapies for primary prevention. Characteristics of physicians indicating they use CHD risk assessments were compared in unadjusted and adjusted analyses.ResultsA total of 952 physicians completed the questionnaire, with 92% reporting awareness of tools available to calculate CHD global risk. Among those aware of such tools, over 80% agreed that CHD risk calculation is useful, improves patient care, and leads to better decisions about recommending preventive therapies. However, only 41% use CHD risk assessment in practice. The most commonly reported barrier to CHD risk assessment is that it is too time consuming. Among respondents who calculate global CHD risk, 69% indicated they use it to guide lipid lowering therapy recommendations; 54% use it to guide aspirin therapy recommendations; and 48% use it to guide BP lowering therapy. Only 40% of respondents who use global CHD risk routinely tell patients their risk. Use of a personal digital assistant or smart phone was associated with reported use of CHD risk assessment (adjusted OR 1.58; 95% CI 1.17-2.12).ConclusionsReported awareness of tools to calculate global CHD risk appears high, but the majority of physicians in this sample do not use CHD risk assessments in practice. A minority of physicians in this sample use global CHD risk to guide prescription decisions or to motivate patients. Educational interventions and system improvements to improve physicians' effective use of global CHD risk assessment should be developed and tested.
Highlights
Global coronary heart disease (CHD) risk assessment is recommended to guide primary preventive pharmacotherapy
CHD = coronary heart disease; PDA = personal digital assistant *Overall P-values based on Pearson’s Chi square †Pearson’s Chi square tests between paired groups yielded p = 0 .072 between cardiologists and family medicine physicians, p < 0 .0001 between cardiologists and general internists, and p = 0.018 between family medicine physicians and general internists. ‡ Pearson’s Chi square tests between paired groups yielded p < 0 .003 for respondents spending > 75% of time vs. those spending 51-74% of time, p < 0 .001 for > 75% vs. 50%, p < 0.03 for 50% of time vs. < 25%
Our study found that among a sample of United States (US) physicians: (1) awareness of tools to calculate CHD global risk is extremely high, (2) use of CHD global risk calculation in practice is low, (3) the most strongly endorsed reason for not calculating a patient’s global CHD risk appears to be that it is too time consuming, (4) overall use of global CHD risk calculation to guide primary preventive pharmacologic therapy is low and infrequently used to guide aspirin recommendations
Summary
Global coronary heart disease (CHD) risk assessment is recommended to guide primary preventive pharmacotherapy. Our objective was to examine US physicians’ awareness, use, and attitudes regarding global CHD risk assessment in clinical practice, and how these vary by provider specialty. Effective clinical primary prevention of CHD requires individualized interventions that range in intensity. In order to appropriately select medical interventions for primary prevention it is necessary to stratify patients based on an assessment of cardiovascular risk [13]. There are many user-friendly, accessible tools available for estimating a patient’s CHD risk including risk charts and risk calculators for personal digital assistants, personal computers, and web-based use [14]. When compared to the full Framingham equations for identifying patients at increased risk, these tools are generally accurate, Framingham-based estimates may not apply to all ethnic groups [3,14]
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