Coronary artery diseaseDiscordance Between Physicians' Estimation of Patient Cardiovascular Risk and Use of Evidence-Based Medical Therapy
Section snippets
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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Cited by (24)
GOAL Canada: Physician Education and Support Can Improve Patient Management
2020, CJC OpenCitation Excerpt :On enrollment, 24% of patients were not on any statin therapy because of intolerance. The etiology of treatment inertia can be multifactorial, including a number of patient- and physician-associated factors.22 We and others15,23–25 have demonstrated that treatment inertia is associated with unfavourable outcomes.
Utilization of Vasculoprotective Therapy for Peripheral Artery Disease: A Systematic Review and Meta-analysis
2018, American Journal of MedicineOptimizing the Prevention of Cardiovascular Events
2016, Canadian Journal of CardiologyCharacteristics and Evidence-Based Management of Stable Coronary Artery Disease Patients in Canada Compared With the Rest of the World: Insights From the CLARIFY Registry
2014, Canadian Journal of CardiologyCitation Excerpt :Last, the CLARIFY registry results may represent progress in the translation of evidence-based medicine and guideline recommendations into routine clinical practice. For example, it was demonstrated in the VP and GOALL registries that reminding and prompting physicians to consider why their patients were not taking such therapy resulted in increased prescriptions for antiplatelet, lipid-lowering, and ACE inhibitor therapies.3 In the past decade since the publication of these results, increased awareness, physician education, pharmacy intervention, and other “gap closing” strategies might have contributed to more ideal use of such therapies, reflected by the higher rates observed in the CLARIFY registry.
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.