American Journal of Cardiology
Volume 102, Issue 9 , Pages 1142-1145 , 1 November 2008

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

  • Jennifer L.Y. Tsang, MD

      Affiliations

    • Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Aurora Mendelsohn, PhD

      Affiliations

    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • ,
  • Mary K.K. Tan, BSc

      Affiliations

    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • ,
  • Daniel G. Hackam, MD

      Affiliations

    • Division of Clinical Pharmacology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
    • Department of Medicine, University of Western Ontario, London, Ontario, Canada
    • Department of Epidemiology Biostatistics, University of Western Ontario, London, Ontario, Canada
    • ,
  • Lawrence A. Leiter, MD

      Affiliations

    • Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • David Fitchett, MD

      Affiliations

    • Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • ,
  • Peter J. Lin, MD

      Affiliations

    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • Health and Wellness Centre, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Etienne Grima, BSc

      Affiliations

    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • ,
  • Anatoly Langer, MD, MSc

      Affiliations

    • Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • ,
  • Shaun G. Goodman, MD, MSc

      Affiliations

    • Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • Canadian Heart Research Centre, Toronto, Ontario, Canada
    • Corresponding Author InformationCorresponding author: Tel: 416-864-5722; fax: 416-864-5407
    • ,
  • Vascular Protection Registry and Guidelines Oriented Approach to Lipid Lowering Registry Investigators

Received 11 January 2008 ,Revised 30 June 2008 ,Accepted 30 June 2008.

References 

  1. Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006;47:2130–2139
  2. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, et al AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases (American Heart Association Science Advisory and Coordinating Committee). Circulation. 2002;106:388–391
  3. Hackam DG, Tan MK, Honos GN, Leiter LA, Langer A, Goodman SG Vascular Protection Registry Investigators. How does the prognosis of diabetes compare with that of established vascular disease? (Insights from the Canadian Vascular Protection (VP) Registry). Am Heart J. 2004;148:1028–1033
  4. Hackam DG, Tan MK, Lin PJ, Mehta PG, Jaffer S, Kates ML, et al. Vascular Protection Registry and Guideline Oriented Approach in Lipid Lowering Registry Investigators (Supporting a call to action for peripheral vascular disease: insights from two prospective registries). J Vasc Surg. 2006;44:776–781
  5. Yan AT, Yan RT, Tan M, Hackam DG, Leblanc KL, Kertland H, et al Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med. 2006;119:676–683
  6. Hackam DG, Leiter LA, Yan AT, Yan RT, Mendelsohn A, Tan M, et al Missed opportunities for the secondary prevention of cardiovascular disease in Canada. Can J Cardiol. 2007;23:1124–1130
  7. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients (The Heart Outcomes Prevention Evaluation Study Investigators). N Engl J Med. 2000;342:145–153
  8. Majumdar SR, McAlister FA, Furberg CD. From knowledge to practice in chronic cardiovascular disease: a long and winding road. J Am Coll Cardiol. 2004;43:1738–1742
  9. Kiefe CI, Allison JJ, Williams OD, Person SD, Weaver MT, Weissman NW. Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial. JAMA. 2001;285:2871–2879
  10. Soumerai SB, McLaughlin TJ, Gurwitz JH, Guadagnoli E, Hauptman PJ, Borbas C, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA. 1998;279:1358–1363
  11. Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, et al A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162:1149–1155
  12. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–1346
  13. Lee CH, Tan M, Yan AT, Yan RT, Fitchett D, Grima EA, et al. The utilization of cardiac catheterization for non-ST-segment elevation acute coronary syndromes according to initial risk: reasons why physicians choose not to refer their patients. Arch Intern Med. 2008;168:291–296

 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.

PII: S0002-9149(08)01139-9

doi: 10.1016/j.amjcard.2008.06.037

American Journal of Cardiology
Volume 102, Issue 9 , Pages 1142-1145 , 1 November 2008

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