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

Heeley, Emma L., Peiris, David P., Patel, Anushka A., Cass, Alan, Weekes, Andrew, Morgan, Clarie, Anderson, Craig S. and Chalmers, John P. (2010). Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). Medical Journal of Australia,192(5):254-259.

Document type: Journal Article

IRMA ID 84473293xPUB32
Title Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study)
Author Heeley, Emma L.
Peiris, David P.
Patel, Anushka A.
Cass, Alan
Weekes, Andrew
Morgan, Clarie
Anderson, Craig S.
Chalmers, John P.
Journal Name Medical Journal of Australia
Publication Date 2010
Volume Number 192
Issue Number 5
ISSN 0025-729X   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-77950613793
Start Page 254
End Page 259
Total Pages 5
Place of Publication Australia
Publisher Australasian Medical Publishing Company Pty. Ltd.
HERDC Category C1 - Journal Article (DIISR)
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 ≥ 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 (≥ 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 (κ = 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.
 
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