Stroke, coronary and peripheral artery disease survey on antithrombotic treatment (START IT)
Hong H Keo1, Cornelius Warncke, Lorenzo Hess
1Swiss Cardiovascular Center, Division of Angiology, Inselspital, Bern University Hospital, Bern, Switzerland.
Insights
Primary care physicians
Area of Science:
- Cardiology
- General Practice
- Pharmacology
Background:
- Established cardiovascular disease (CVD) patients face risks of subsequent atherothrombotic events.
- Accurate risk perception by primary care physicians (PCPs) is crucial for appropriate antithrombotic therapy.
- Current guidelines for antithrombotic treatment in high-risk CVD patients require clear evidence.
Purpose of the Study:
- To assess PCPs' perception of subsequent atherothrombotic event risk in patients with established CVD.
- To correlate PCP risk perception with prescribed antithrombotic therapy.
- To investigate the influence of perceived risk on treatment decisions.
Main Methods:
- Cross-sectional study involving 381 PCPs in Switzerland.
- Screening of 127,040 outpatients over 15 workdays in 2006.
- Risk perception assessed via questionnaire (low, moderate, high, very high risk); logistic regression used to analyze treatment correlations.
Main Results:
- 10.4% of patients had established CVD; 48.8% were perceived as high/very high risk.
- Higher perceived risk correlated with increased use of clopidogrel, vitamin K antagonists, or dual antiplatelet therapy (aspirin + clopidogrel).
- Specific therapies (clopidogrel, VKA, aspirin + clopidogrel) were prescribed more frequently in high-risk patients.
Conclusions:
- PCPs' risk perception for atherothrombotic events in CVD patients varies significantly.
- Perceived risk influences antithrombotic therapy choices, potentially leading to deviations from evidence-based guidelines.
- There is a need for clearer guidelines on antithrombotic treatment for high-risk CVD patients.
Questions Under Study:
To determine the perception of primary care physicians regarding the risk of subsequent atherothrombotic events in patients with established cardiovascular (CV) disease, and to correlate this perception with documented antithrombotic therapy.
Methods:
In a cross-sectional study of the general practice population in Switzerland, 381 primary care physicians screened 127 040 outpatients during 15 consecutive workdays in 2006. Perception of subsequent atherothrombotic events in patients with established CV disease was assessed using a tick box questionnaire allowing choices between low, moderate, high or very high risk. Logistic regression models were used to determine the relationship between risk perception and antithrombotic treatment.
Results:
Overall, 13 057 patients (10.4%) were identified as having established CV disease and 48.8% of those were estimated to be at high to very high risk for subsequent atherothrombotic events. Estimated higher risk for subsequent atherothrombotic events was associated with a shift from aspirin monotherapy to clopidogrel, vitamin K antagonist or aspirin plus clopidogrel (p <0.001 for trend). Clopidogrel (12.7% vs 6.8%, p <0.001), vitamin K antagonist (24.5% vs 15.6%, p <0.001) or aspirin plus clopidogrel (10.2% vs 4.2%, p <0.001) were prescribed in patients estimated to be at high to very high risk more often than in those at low to moderate risk.
Conclusions:
Perception of primary care physicians regarding risk of subsequent atherothrombotic events varies in patients with CV disease, and as a result antithrombotic therapy is altered in patients with anticipated high to very high risk even though robust evidence and clear guidelines are lacking.
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