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Primary prevention of cardiovascular diseases in general practice: mismatch between cardiovascular risk and patients'
T van der Weijden1, B van Steenkiste, H E J H Stoffers
1Department of General Practice/Centre for Quality of Care Research (WOK), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands. Trudy.vanderWeijden@hag.unimaas.nl
Insights
Many patients misperceive their cardiovascular disease (CVD) risk, hindering prevention efforts. General practitioners (GPs) often see low-risk patients, with risk perception not matching actual CVD risk, especially in men and diabetic individuals.
Area of Science:
- Cardiology
- General Practice
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) prevention guidelines focus on high-risk patients.
- Patient misconceptions about CVD risk impede effective prevention strategies.
- Understanding patient risk perception in general practice is crucial for improving CVD prevention.
Purpose of the Study:
- To investigate the appropriateness of risk perceptions and worries of patients discussing CVD risks with general practitioners (GPs).
- To identify factors influencing inappropriate risk perception in patients undergoing CVD risk assessment.
- To characterize the patient population encountered by GPs during cardiovascular prevention consultations.
Main Methods:
- A cross-sectional study involving 34 general practices.
- Inclusion of patients aged 40-70 years discussing CVD risk during consultations.
- Data collection via GP registration forms and patient questionnaires, followed by correlation analysis of actual CVD risk and perceived risk.
Main Results:
- 17% of consultations involved high-risk patients.
- Nearly 80% of high-risk patients exhibited incorrect optimism, while 20% of low-risk patients showed incorrect pessimism.
- Smoking, hypertension, and obesity correlated with higher perceived CVD risk; diabetic patients and men showed striking inappropriate risk perceptions.
Conclusions:
- GPs primarily encounter low-risk patients, with perceived risk often misaligned with actual CVD risk.
- Awareness of patient misconceptions, particularly 'incorrect optimism' in men and diabetic patients, is vital for effective CVD risk communication.
- Addressing inappropriate risk perceptions is key to enhancing the implementation of cardiovascular disease prevention guidelines.
Objective:
Guidelines on primary prevention of cardiovascular disease (CVD) emphasize identifying high-risk patients for more intensive management, but patients' misconceptions of risk hamper implementation. Insight is needed into the type of patients that general practitioners (GPs) encounter in their cardiovascular prevention activities. How appropriate are the risk perceptions and worries of patients with whom GPs discuss CVD risks? What determines inappropriate risk perception?
Method:
Cross-sectional study in 34 general practices. The study included patients aged 40 to 70 years with whom CVD risk was discussed during consultation. After the consultation, the GPs completed a registration form, and patients completed a questionnaire. Correlations between patients' actual CVD risk and risk perceptions were analyzed.
Results:
In total, 490 patients were included. In 17% of the consultations, patients were actually at high risk. Risk was perceived inappropriately by nearly 4 in 5 high-risk patients (incorrect optimism) and by 1 in 5 low-risk patients (incorrect pessimism). Smoking, hypertension, and obesity were determinants of perceiving CVD risk as high, whereas surprisingly, diabetic patients did not report any anxiety about their CVD risk. Men were more likely to perceive their CVD risk inappropriately than women.
Conclusion:
In communicating CVD risk, GPs must be aware that they mostly encounter low-risk patients and that the perceived risk and worry do not necessarily correspond with the actual risk. Incorrect perceptions of CVD risk among men and patients with diabetes were striking.
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