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

Emma Heeley, David Peiris, Anushka Patel, Alan Cass, Andrew Weekes, Claire Morgan, Craig Anderson, John Chalmers

Research output: Contribution to journalArticleResearchpeer-review

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.
Original languageEnglish
Pages (from-to)254-259
Number of pages6
JournalMedical Journal of Australia
Volume192
Issue number5
DOIs
Publication statusPublished - Mar 2010
Externally publishedYes

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General Practice
Hypertension
Cardiovascular Diseases
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors
Guidelines
Professional Practice Gaps
Social Adjustment
Vascular Diseases
General Practitioners
Primary Health Care
Outcome Assessment (Health Care)
Blood Pressure
Drug Therapy

Cite this

Heeley, Emma ; Peiris, David ; Patel, Anushka ; Cass, Alan ; Weekes, Andrew ; Morgan, Claire ; Anderson, Craig ; Chalmers, John. / Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). In: Medical Journal of Australia. 2010 ; Vol. 192, No. 5. pp. 254-259.
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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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Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). / Heeley, Emma; Peiris, David; Patel, Anushka; Cass, Alan; Weekes, Andrew; Morgan, Claire; Anderson, Craig; Chalmers, John.

In: Medical Journal of Australia, Vol. 192, No. 5, 03.2010, p. 254-259.

Research output: Contribution to journalArticleResearchpeer-review

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