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Assessment of coronary heart disease risk, II. A clinical multicentre study of general practitioners' risk assessment
E Meland1, E Laerum, E H Lehmann
1Department of Public Health and Primary Health Care, Division for General Practice, Bergen, Norway.
Insights
General practitioners (GPs) showed a weak correlation between clinical and simulated coronary heart disease (CHD) risk assessments. Formal risk estimation tools are recommended to improve accuracy in clinical practice.
Area of Science:
- Cardiology
- General Practice
- Preventive Medicine
Background:
- Accurate assessment of coronary heart disease (CHD) risk is crucial for preventive strategies.
- General practitioners (GPs) play a key role in opportunistic screening for CHD risk factors.
- Current clinical risk assessment methods may have limitations in accuracy.
Purpose of the Study:
- To compare the accuracy of CHD risk assessment by GPs using clinical judgment versus simulated case histories.
- To evaluate the performance of GPs in assessing CHD risk in a real-world clinical setting.
- To identify factors influencing GPs' risk assessment accuracy.
Main Methods:
- Thirty-one GPs assessed CHD risk for 20 male patients (aged 30-59) and 10 written case histories.
- Risk assessment was compared against a gold standard 'infarction score'.
- Pearson's correlation was used to compare diagnostic performance between clinical and simulated settings.
Main Results:
- A weak but significant positive correlation was found between correct risk estimation in clinical versus simulated settings.
- Sensitivity for detecting risk was higher in the clinical setting, but specificity was lower.
- Family history positively impacted clinical assessment, mirroring epidemiological estimates, while other factors had less influence than expected.
Conclusions:
- Clinical risk assessment by GPs shows moderate agreement with simulated assessments, but accuracy needs improvement.
- Formal risk estimation tools are advocated to enhance the precision of CHD risk assessment.
- Medical training should emphasize the synergistic effects of multiple risk factors to improve clinical risk estimation.
Abstract:
The objectives of the present study were: (i) to compare clinical assessment of coronary heart disease (CHD) risk with risk estimation faced with simulated, written case histories; (ii) to observe the risk assessment performed by general practitioners (GPs) in their clinical setting. Thirty-one GPs participating in a multicentre study were asked to invite 20 consecutive male patients aged 30-59 years to an opportunistic screening of CHD risk factors. They assessed the risk status of these patients and of 10 written case histories containing information about corresponding CHD risk factors. A composite 'infarction score' computed from epidemiologic data was used as a gold standard. Diagnostic performance in the clinical setting was compared with that in the simulated setting by Pearson's correlation. A weak, but statistically significant positive correlation was demonstrated when comparing correct estimation in the two settings. No correlation was found for over- and underestimation. Sensitivity was increased faced with clinical patients at the sacrifice of specificity compared to the simulated setting. The impact of a positive family history on clinical assessment parallels the epidemiological estimate. Due to lack of sensitivity, the other factors had a lower impact on risk estimation than an epidemiological estimate would presuppose. We advocate the application of a formal risk estimation to improve risk assessment accuracy. The synergistic effect of multiple risk factors should be emphasized in medical training to improve the clinical risk estimation.