Coronary artery disease
Discordance Between Physicians' Estimation of Patient Cardiovascular Risk and Use of Evidence-Based Medical Therapy

https://doi.org/10.1016/j.amjcard.2008.06.037Get rights and content

Despite clinical trial evidence supporting the use of antiplatelets, angiotensin-converting enzyme inhibitors, and statins for cardiovascular risk reduction in high-risk patients, use of such therapies in real-world outpatients in the prospective Vascular Protection Registry and the Guidelines Oriented Approach to Lipid Lowering Registry was suboptimal (78%, 55%, and 75%, respectively). The most frequent reason physicians cited for nonprescription of statins (33%) was that patients were not high risk enough and/or current guidelines did not support statin use. In conclusion, outpatients at high cardiovascular risk continue to be undertreated as a result of a combination of physician underestimation of cardiovascular risk (knowledge gap) and barriers to implementation of evidence-based therapy (practice gap).

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Methods and Results

The VP and GOALL Registries were prospective observational outpatient practice-based registries designed, implemented, and managed by the Canadian Heart Research Centre (Toronto, Canada; a federally incorporated nonprofit academic research organization). The purpose of these registries was to monitor management and outcomes in patients at high risk of vascular events (3% to 5%/year average risk of a severe cardiovascular event) and identify gaps between patient care recommended in guidelines

Discussion

In this study, we report the prescription pattern of evidence-based medicine for patients with high cardiovascular risk based on 2 large national outpatient registries. We found that despite ample evidence and guideline recommendations for the use of antiplatelets, ACE inhibitors, and statins in patients at high cardiovascular risk, a significant care gap still exists in Canada. Most importantly, we uniquely described the reasons these high-risk patients were not on appropriate medical therapy

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This work was supported by the Canadian Heart Research Centre, Toronto, Ontario, Canada, Pfizer, Kirkland, Quebec, Canada, Sanofi Aventis, Laval, Quebec, Canada, and Astra Zeneca, Mississauga, Canada. Drs. Leiter, Fitchett, Langer, and Goodman have received speaker/consulting honoraria and/or research grant support from the co-sponsors.

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