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A comparison of primary versus secondary cardiovascular disease prevention in an academic family practice
C B Eaton1, W McQuade, D Glupczynski
1Department of Family Medicine, Brown University School of Medicine, Memorial Hospital of Rhode Island, Pawtucket.
Insights
Physicians identified cardiovascular disease (CVD) risk factors in most patients but did not manage them more aggressively in those with existing CVD. Secondary prevention strategies for CVD were suboptimal, particularly for lipid disorders.
Area of Science:
- Cardiology
- Family Medicine
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) poses a significantly higher mortality risk for individuals with pre-existing CVD.
- Modifying risk factors is crucial for reducing CVD-related mortality.
- This study investigates physician management of CVD risk factors in patients with and without established CVD.
Purpose of the Study:
- To determine if physicians manage CVD risk factors differently in patients with and without overt CVD.
- To compare secondary and primary prevention strategies for CVD risk factors.
Main Methods:
- A chart audit analyzed risk factor identification and management in 61 patients with premature CVD (secondary prevention) and 61 age-matched controls (primary prevention).
- Patients were from an academic family practice, with at least two physician visits between 1982-1992.
Main Results:
- Family physicians identified CVD risk factors in most patients.
- Few differences were observed in risk factor counseling and management between secondary and primary prevention groups.
- Hypertension management was effective (94% achieved <140/90 mmHg).
- Lipid disorders were primarily managed with diet; only 20% of hyperlipidemia cases received pharmacologic therapy, with only 2.5% achieving controlled cholesterol levels (<200 mg/dl).
Conclusions:
- CVD risk factor identification was high in this academic family practice, but management practices for secondary prevention were suboptimal.
- CVD risk factor management was not more aggressive in secondary prevention cases compared to primary prevention controls.
Background:
The risk of mortality from cardiovascular disease (CVD) is much higher in those with preexisting CVD than in those without it. Risk factor modification can reduce these risks. This study was designed to determine whether physicians manage risk factors differently in patients with and without overt CVD.
Methods:
Risk factor identification and management strategies after the diagnosis of CVD (secondary prevention) were analyzed by chart audit for 61 patients with premature CVD and 61 age-matched patients free of CVD (primary prevention). All of these patients had entered an academic family practice within 1 year of each other and had at least two physician visits between 1982-1992.
Results:
In the majority of patients, risk factors for CVD were identified by family physicians. Few differences in counseling and management of risk factors were noted between patients with premature CVD and those free of CVD. Management of hypertension was performed with behavioral and pharmacologic therapy; more than 94% of the patients had at least one posttreatment blood pressure below 140/90. Lipid disorders, however, were managed primarily by diet; only 20% of cases with hyperlipidemia and premature CVD received pharmacologic therapy, and only 2.5% had a controlled blood cholesterol level (below 200 mg/dl).
Conclusions:
In an academic family practice, CVD risk factor identification was high but recommended management practices in the secondary prevention of CVD were suboptimal. Management of CVD risk factors was not more aggressive among secondary prevention cases compared to primary prevention controls.