Overestimation and underestimation of cardiovascular risk in clinical practice: usefulness of risk estimation charts

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Decision Making

Background:

• Cardiovascular risk charts are crucial for managing asymptomatic individuals.
• Physicians often make management decisions without consulting these risk assessment tools.
• This study evaluated the accuracy of clinical judgment against established guidelines.

Purpose of the Study:

• To quantify the extent of cardiovascular risk overestimation and underestimation in clinical practice.
• To compare physician-based risk assessment with European Society of Cardiology guidelines.
• To identify discrepancies in managing intermediate cardiovascular risk cases.

Main Methods:

• Thirty primary care physicians assessed seven anonymized patient cases with varying cardiovascular risk profiles.
• Physicians determined the need for hypolipidaemic therapy for each case.
• Responses were compared against recommendations from European cardiovascular prevention guidelines and risk charts.

Main Results:

• Overall agreement with guidelines was 70%, with absolute agreement in very low and very high-risk cases.
• Agreement significantly decreased in intermediate-risk cases, particularly those with cholesterol levels between 200-240 mg/dL (40% agreement).
• Both overestimation and underestimation of cardiovascular risk were observed in intermediate cases.

Conclusions:

• Physician judgment aligns with guidelines for clear-cut low or high cardiovascular risk.
• Intermediate cardiovascular risk cases show significant variability, leading to inappropriate hypolipidaemic treatment prescriptions or missed therapeutic opportunities.
• Implementing cardiovascular risk charts in practice can promote more objective and evidence-based preventive strategies.