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Obstacles to cardiovascular prevention in general practice
Régis De Muylder1, Vincent Lorant, Dominique Paulus
1School of Public Health, Unit of Epidemiology, Université catholique de Louvain, Brussels, Belgium.
Insights
General practitioners (GPs) often underestimate cardiovascular disease risks and lack systematic approaches to prevention. This study identifies key obstacles in GP knowledge and attitudes hindering effective cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- General Practice
- Public Health
Background:
- European guidelines for cardiovascular (CV) disease prevention are widely disseminated.
- Despite guidelines, primary and secondary CV prevention efforts face acknowledged failures.
Purpose of the Study:
- To identify obstacles to CV prevention.
- To investigate general practitioner (GP) knowledge and attitudes impacting CV prevention.
Main Methods:
- A postal questionnaire was distributed to a random sample of GPs in two Belgian provinces.
- 282 GPs responded (32% response rate).
- Analysis focused on the proportion of adequate answers regarding CV burden awareness, risk assessment, and therapeutic attitudes.
Main Results:
- 83% of GPs underestimated myocardial infarction lethality; 41% underestimated high CV risk prevalence.
- 80% believed total cholesterol adequately reflected CV risk; only 55% systematically recorded CV risk factors.
- 53% of GPs never used a global CV risk assessment tool; 66% prescribed lipid-lowering drugs for high total cholesterol without considering evidence-based targets for type 2 diabetes.
Conclusions:
- GPs demonstrated underestimation of the CV disease burden.
- A lack of systematic global CV risk assessment was evident.
- Focus on cholesterol treatment overshadowed comprehensive CV risk management.
Objective:
In spite of a wide diffusion of the European guidelines for prevention of cardiovascular (CV) diseases, failures in both primary and secondary CV prevention are currently acknowledged. We wanted to uncover obstacles to CV prevention related to the general practitioner's (GP) knowledge and attitudes.
Methods And Results:
A postal questionnaire was sent to a random sample of GPs from two Belgian provinces. 282 GPs (32%) answered the questionnaire. The proportion of adequate answers was calculated for each item. The main obstacles related to three domains. Regarding awareness of CV burden, 83% of the GPs underestimated the lethality of myocardial infarction and 41% underestimated the prevalence of high CV risk in the adult population. Regarding CV risk assessment, 80% thought that total cholesterol (TC) adequately reflected the individual CV risk; only 55% systematically registered the patient's CV risk factors in the medical record. A tool for global CV risk assessment was never used by 53% of the GPs. Regarding CV therapeutic attitudes, 66% systematically prescribed a lipid-lowering drug to patients with high TC while 62% did not take into account the evidence-based therapeutic targets in type 2 diabetic patients.
Conclusions:
This survey showed that these GPs underestimated the CV burden, lacked a systematic approach to global risk assessment and used to focus on cholesterol treatment rather than on global CV risk management.
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