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Cardiovascular risk perception and evidence–practice gaps in Australian general practice (the AusHEART study)

Emma L Heeley, David P Peiris, Anushka A Patel, Alan Cass, Andrew Weekes, Claire Morgan, Craig S Anderson and John P Chalmers
Med J Aust 2010; 192 (5): 254-259.

Summary

Objective: To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care.

Design, setting and participants: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey of 322 general practitioners. Each GP was asked to collect data on CVD risk factors and their management in 15–20 consecutive patients aged ≥ 55 years who presented between April and June 2008, and to estimate each patient’s absolute risk of a cardiovascular event in the next 5 years.

Main outcome measures: Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment.

Results: Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (≥ 15%) 5-year risk of a cardiovascular event. Of the 1548 patients with established CVD, 50% were prescribed a combination of a blood pressure (BP)-lowering medication, a statin and an antiplatelet agent, and 9% were prescribed a BP-lowering medication and a statin but not an antiplatelet agent. Among high-risk patients without established CVD, categorised using NHF 2004 adjustments, 34% were prescribed a combination of a BP-lowering medication and a statin. GPs estimated 60% of patients with established CVD as having a risk of less than 15%. The GPs’ estimates of risk among patients without established CVD agreed with the centrally calculated estimate (according to the NHF 2004 guideline) in 48% of instances (κ = 0.21).

Conclusions: These data confirm substantial undertreatment of patients who are at high risk of a cardiovascular event. We recommend that GPs assess absolute risk for older patients and ensure that high-risk patients receive evidence-based pharmacotherapy.

  • Emma L Heeley1
  • David P Peiris1,2
  • Anushka A Patel1
  • Alan Cass1
  • Andrew Weekes3
  • Claire Morgan3
  • Craig S Anderson1
  • John P Chalmers1

  • 1 The George Institute for International Health and the University of Sydney, Sydney, NSW.
  • 2 Tharawal Aboriginal Corporation, Sydney, NSW.
  • 3 Medical Department, Servier Australia, Melbourne, VIC.

Correspondence: eheeley@george.org.au

Acknowledgements: 

We thank the 532 GP investigators who participated in the study. Those who submitted data for 15 or more patients were eligible for 40 Category 1 points for RACGP continuing professional development program. Dr Peter Arnold helped draft the manuscript. Data were collected and initially analysed by Statistical Revelations, Melbourne. We also thank Catherine Devlin for help with collating data and Ruth Webster for help with interpreting the guidelines.

Competing interests:

The AusHEART study was conducted as a collaborative project between the George Institute for International Health and Servier Australia. Emma Heeley received a travel grant from Servier to present AusHEART findings at the European Stroke Conference. Anushka Patel has received speaker fees and travel assistance from Servier. Alan Cass has received an honorarium for speaking at a national education meeting sponsored by Servier. Andrew Weekes and Claire Morgan are employed by Servier Australia and collaborated with the George Institute investigators in the study design and review of the submitted article. Craig Anderson has received speaker fees and educational grants from Boehringer Ingelheim, Servier, Pfizer and Genzyme, and travel assistance to attend meetings from Sanofi-Aventis, Boehringer Ingelheim, Mayo Clinic and the Korean Stroke Society. John Chalmers has received research grants from Servier for the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), the Action in Diabetes and Vascular Disease Preterax and Diamicron MR Controlled Evaluation (ADVANCE) and the AusHEART study, and has received lecture fees for speaking at scientific meetings from Servier.

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