Physicians’ attitudes and adherence to use of risk scores for primary prevention of cardiovascular disease: cross-sectional survey in three world regions

ABSTRACT

Objective: To evaluate physicians’ attitudes and adherence to the use of risk scores in the primary prevention of cardiovascular disease (CVD).

Design and methods: A cross-sectional survey of 2056 physicians involved in the primary prevention of CVD. Participants included cardiologists (47%), general practitioners (42%), and endocrinologists (11%) from several geographical regions: Brazil (n = 968), USA (n = 381), Greece (n = 275), Chile (n = 157), Venezuela (n = 128), Portugal (n = 42), The Netherlands (n = 41), and Central America (Costa Rica, Panama, El Salvador and Guatemala; n = 64).

Results: The main outcome measure was the percentage of responses on a multiple-choice questionnaire describing a hypothetical asymptomatic patient at intermediate risk for CVD according to the Framingham Risk Score.

Only 48% of respondents reported regular use of CVD risk scores to tailor preventive treatment in the case scenario. Of non-users, nearly three-quarters indicated that ‘It takes up too much of my time’ (52%) or ‘I don’t believe they add value to the clinical evaluation’ (21%).

Only 56% of respondents indicated that they would prescribe lipid-lowering therapy for the hypothetical intermediate-risk patient. A significantly greater proportion of regular users than non-users of CVD risk scores identified the need for lipid-lowering therapy in the hypothetical patient (59 vs. 41%; p < 0.0001).

Conclusions: Based on a survey conducted in a ‘real-world’ setting, risk scores are generally not used by a majority of physicians to guide primary prevention in asymptomatic persons at intermediate risk for CVD. Appropriate prescribing of lipid-lowering therapy in such patients is equally neglected. Changing physicians’ attitudes towards the use of CVD risk scores is one of several challenges that need to be addressed to reduce the world-wide burden of CVD.

Key words: :

• Cardiovascular risk
• Dyslipidemia
• Lipid-lowering therapy
• Primary prevention

Acknowledgments

Declaration of interest: There was no financial compensation for study participants or investigators. Indirect funding for this survey was provided by pharmaceutical companies and local medical societies through the support of continuing medical education meetings at which the survey questionnaire was delivered. M.M.G. is an employee of Novartis Pharma AG.A.C.S., J.AF.R., J.W.J., J.C.M., P.M.S. and P.WF.W have no conflicts of interest to declare with regards to the contents of this article. A.C.S. had full access to all data in the study, performed all statistical analyses in close consultation with P.WF.W., and takes responsibility for data integrity as well as accuracy of the data analysis. Editorial assistance was provided by Kerry Dechant and ContentEdNet, and this assistance was funded by Schering Plough.