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Physicians' ability to predict the risk of coronary heart disease
Michael Pignone1, Christopher J Phillips, Tom A Elasy
1Division of General Internal Medicine and Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA. pignone@med.unc.edu
Insights
Physicians often overestimate coronary heart disease (CHD) risk and treatment benefits. Accurate risk assessment is crucial for effective cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Coronary heart disease (CHD) is a leading cause of mortality in the US.
- Physicians tend to overestimate cardiovascular risk, but this has been studied in limited scenarios.
- This study assesses physician risk estimation for CHD in primary prevention.
Purpose of the Study:
- To measure physicians' ability to estimate the 5-year risk of CHD events.
- To evaluate physician accuracy in estimating risk reduction with lipid-lowering therapy.
- To compare physician estimates with Framingham risk equation calculations.
Main Methods:
- Developed 12 primary prevention scenarios with 5-year CHD risk.
- Surveyed internal medicine residents, fellows, and attending physicians at 3 university hospitals.
- Assessed baseline risk estimates and revised risk estimates with hypothetical lipid-lowering therapy.
Main Results:
- Only 24% of physicians' absolute risk estimates were accurate.
- Most physicians overestimated absolute CHD risk, particularly for patients with high cholesterol.
- Physician estimates of relative risk reduction from therapy were more accurate (43% within 25-40% range).
Conclusions:
- Physicians overestimate absolute CHD risk and the potential absolute benefit of drug therapy.
- Risk communication and education may be needed to improve physician accuracy.
- Despite overestimation, most physicians recommended treatment when appropriate.
Background:
Coronary heart disease (CHD) is the leading cause of death in the United States. Previous research examining physicians ability to estimate cardiovascular risk has shown that physicians' generally overestimate the absolute risk of CHD events. This question has, however, only studied risk prediction for a limited number of patient care scenarios. The aim of this study is to measure the ability of physicians to estimate the risk of CHD events in patients with no previous history of coronary heart disease.
Methods:
Twelve primary prevention scenarios with a 5-year risk of CHD events were developed. This questionnaire was surveyed at 3 university teaching hospitals where the participants were a convenience sample of internal medicine residents and fellows or attending physicians in general internal medicine or cardiology. For each scenario, physicians were asked to estimate the baseline 5-year risk of a coronary heart disease event and the revised risk if the patient were to receive lipid-lowering drug therapy. Estimates of the baseline 5-year risk were compared with values calculated from Framingham risk equations. Inaccurate responses were defined as those with a ratio of estimated to actual risk of more than 1.5 or less than 0.67. Physicians' estimates of the relative risk reduction with therapy were considered to be accurate if they were between 25% and 40%.
Results:
79 physicians (53 residents, 8 fellows, 18 attending physicians) completed the survey. Only 24% of physicians' risk estimates were accurate. In most cases, physicians overestimated the absolute risk of cardiovascular events without therapy (proportion overestimating ranged from 32-92% for the 12 individual scenarios). Physicians made larger errors in patient scenarios involving patients with high total or LDL cholesterol levels. Physicians' estimates of the relative risk reduction from treatment were more accurate: 43% of estimates were between 25 and 40%. Over 85% of physicians recommended treatment in 10 of 12 scenarios.
Conclusions:
Physicians overestimate the absolute risk of CHD events and the potential absolute benefit of drug therapy.
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