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Discordance between physicians' estimation of patient cardiovascular risk and use of evidence-based medical therapy

Jennifer L Y Tsang1, Aurora Mendelsohn, Mary K K Tan

  • 1Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

The American Journal of Cardiology
|October 23, 2008
PubMed

Insights

High-risk patients with cardiovascular disease are undertreated with essential therapies like antiplatelets and statins. Physician knowledge gaps and implementation barriers contribute to this suboptimal real-world treatment.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Health Services Research

Background:

  • Evidence-based guidelines recommend antiplatelets, ACE inhibitors, and statins for cardiovascular risk reduction.
  • Real-world adherence to these recommendations in high-risk outpatients is not well-documented.

Purpose of the Study:

  • To assess the utilization of key cardiovascular therapies in high-risk outpatients.
  • To identify reasons for suboptimal prescribing patterns.

Main Methods:

  • Analysis of data from the prospective Vascular Protection Registry and the Guidelines Oriented Approach to Lipid Lowering Registry.
  • Physician-reported reasons for non-prescription were collected.

Main Results:

  • Suboptimal use of antiplatelets (78%), ACE inhibitors (55%), and statins (75%) was observed.
  • Physicians cited "not high risk enough" or guideline limitations as primary reasons for not prescribing statins (33%).

Conclusions:

  • High-risk outpatients are undertreated due to physician underestimation of risk (knowledge gap).
  • Barriers to implementing evidence-based therapies (practice gap) also contribute to undertreatment.

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