Coronary artery disease| Volume 102, ISSUE 9, P1142-1145, November 01, 2008

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

      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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        • Smith Jr., S.C.
        • Allen J.
        • Blair S.N.
        • Bonow R.O.
        • Brass L.M.
        • Fonarow G.C.
        • Grundy S.M.
        • Hiratzka L.
        • Jones D.
        • Krumholz H.M.
        • 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
        • Pearson T.A.
        • Blair S.N.
        • Daniels S.R.
        • Eckel R.H.
        • Fair J.M.
        • Fortmann S.P.
        • Franklin B.A.
        • Goldstein L.B.
        • Greenland P.
        • Grundy S.M.
        • 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.
        Circulation. 2002; 106: 388-391
        • Hackam D.G.
        • Tan M.K.
        • Honos G.N.
        • Leiter L.A.
        • Langer A.
        • Goodman S.G.
        • Vascular Protection Registry Investigators
        How does the prognosis of diabetes compare with that of established vascular disease?.
        Am Heart J. 2004; 148: 1028-1033
        • Hackam D.G.
        • Tan M.K.
        • Lin P.J.
        • Mehta P.G.
        • Jaffer S.
        • Kates M.L.
        • Oh M.
        • Grima E.A.
        • Langer A.
        • Goodman S.G.
        Vascular Protection Registry and Guideline Oriented Approach in Lipid Lowering Registry Investigators.
        J Vasc Surg. 2006; 44: 776-781
        • Yan A.T.
        • Yan R.T.
        • Tan M.
        • Hackam D.G.
        • Leblanc K.L.
        • Kertland H.
        • Tsang J.L.
        • Jaffer S.
        • Kates M.L.
        • Leiter L.A.
        • et al.
        • Vascular Protection (VP) and Guidelines Oriented Approach to Lipid Lowering (GOALL) Registries Investigators
        Contemporary management of dyslipidemia in high-risk patients: targets still not met.
        Am J Med. 2006; 119: 676-683
        • Hackam D.G.
        • Leiter L.A.
        • Yan A.T.
        • Yan R.T.
        • Mendelsohn A.
        • Tan M.
        • Zavodni L.
        • Chen R.
        • Tsang J.L.
        • Kundi A.
        • et al.
        Missed opportunities for the secondary prevention of cardiovascular disease in Canada.
        Can J Cardiol. 2007; 23: 1124-1130
        • 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.
        N Engl J Med. 2000; 342: 145-153
        • Majumdar S.R.
        • McAlister F.A.
        • Furberg C.D.
        From knowledge to practice in chronic cardiovascular disease: a long and winding road.
        J Am Coll Cardiol. 2004; 43: 1738-1742
        • Kiefe C.I.
        • Allison J.J.
        • Williams O.D.
        • Person S.D.
        • Weaver M.T.
        • Weissman N.W.
        Improving quality improvement using achievable benchmarks for physician feedback: a randomized controlled trial.
        JAMA. 2001; 285: 2871-2879
        • Soumerai S.B.
        • McLaughlin T.J.
        • Gurwitz J.H.
        • Guadagnoli E.
        • Hauptman P.J.
        • Borbas C.
        • Morris N.
        • McLaughlin B.
        • Gao X.
        • Willison D.J.
        • Asinger R.
        • Gobel F.
        Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial.
        JAMA. 1998; 279: 1358-1363
        • Tsuyuki R.T.
        • Johnson J.A.
        • Teo K.K.
        • Simpson S.H.
        • Ackman M.L.
        • Biggs R.S.
        • Cave A.
        • Chang W.C.
        • Dzavik V.
        • Farris K.B.
        • 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
        • Hunt D.L.
        • Haynes R.B.
        • Hanna S.E.
        • Smith K.
        Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review.
        JAMA. 1998; 280: 1339-1346
        • Lee C.H.
        • Tan M.
        • Yan A.T.
        • Yan R.T.
        • Fitchett D.
        • Grima E.A.
        • Langer A.
        • Goodman S.G.
        • Canadian Acute Coronary Syndromes II (ACS II) Registry Investigators
        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