NEW YORK (Reuters Health) -
Some doctors are not making the
grade when it comes to helping their patients ward off heart
disease, a new survey suggests.

The survey, of nearly 900 U.S. primary care doctors, found
that many do not follow practice guidelines on managing
patients who are at elevated risk of heart and blood vessel
disease.

“Despite the benefits demonstrated for managing
cardiovascular risks, gaps remain in primary care
practitioners' management of risks according to guideline
recommendations,” conclude researchers in a report in the
journal BMC Family Practice.

“Patients should talk to their physicians about setting
goals together for reducing blood pressure and cholesterol and
making a plan to achieve the goals,” lead researcher Dr.
Hamidreza Doroodchi, from Birmingham, Alabama-based Outcomes,
Inc., noted in comments to Reuters Health.

Doroodchi and colleagues sent a survey on cardiovascular
disease management to a random sample of 12,000 U.S. family
physicians and general internists. A total of 888 completed the
survey, which contained “case vignettes” for managing adults
deemed to be at low or high risk of heart disease.

The study found that in the hypothetical case of a low-risk
45-year-old woman, only 28 percent of family doctors and 37
percent of internists made the “guideline-based preventive
choice” of prescribing no aspirin or other antiplatelet therapy
– drugs that help prevent blood clots by keeping platelet
blood cells from clumping together. The majority indicated that
they would prescribe a daily aspirin for such a patient to
reduce the risk of heart attack.

When asked whether they would start drug therapy to combat
abnormal cholesterol levels, 51 percent of doctors said they
would not do so in this low-risk patient — which is in
accordance with guidelines. On the other hand, 41 percent said
they would prescribe a statin.

When it came to basic lifestyle advice, which is
appropriate for low- and high-risk patients alike, doctors
often fell short.

For example, while experts recommend that all adults limit
their intake of artery-clogging trans fats, over one-third of
doctors in the survey failed to recommend this measure for the
low-risk 45-year-old woman.

For a 50-year-old man at high risk for heart disease, only
59 percent of family doctors and 56 percent of internists
correctly identified the guideline-based goal of keeping “bad”
LDL cholesterol below 100 milligrams per deciliter.

Similarly, for a 78-year-old woman at high risk for heart
disease but no obvious symptoms, only about half of family
doctors and internists were in accordance with guidelines to
order a stress test should she develop chest pain or shortness
of breath.

Doctors in practice for 10 years or less were much more
likely than doctors in practice for more than 10 years to make
appropriate guideline-based choices for the prevention of heart
disease. Younger doctors were also more apt to adhere to
guidelines than were more experienced doctors.

Doroodchi and colleagues found it “especially concerning”
that doctors who see a greater percentage of patients with high
blood pressure and cholesterol abnormalities were significantly
less likely to offer guideline-based care.

“Innovative educational approaches,” they conclude, “are
needed to address barriers, and target specific groups of
physicians to facilitate implementation of guideline-based
recommendations for cardiovascular management.”

The findings should not, however, be taken as a sign that
doctors lack concern for their patients, according to
Doroodchi.

“Most primary care physicians are concerned about
cardiovascular risk in their patients and set goals for their
patients to reduce this risk,” the researcher said. “Physicians
are concerned that their patients do not follow their advice
about changes in exercise and diet, and (that) they do not
always take the medicine that is prescribed.”

SOURCE: BMC Family Practice, July 8, 2008.