Assessment of coronary risk in general practice in relation to the use of guidelines: a survey in Denmark.

Abstract

There is a considerable gap between recommended and actually conducted preventive cardiology in general practice. The effect of guidelines is not fully evaluated. A questionnaire containing 10 questions on preventive cardiology, including the use of clinical guidelines, together with four case stories for cardiovascular risk estimation was mailed to 205 general practitioners (GPs). Response rate was 81%. Twenty-five percent of the GPs had consultations in preventive cardiology at least once a day and 60% of the GPs thought lifestyle intervention had significant effect on cardiovascular risk. Approximately two-thirds of the GPs were regular users of national guidelines on prevention of cardiovascular disease. While the majority of GPs correctly assigned a patient with multiple risk factors to the high-risk category there was a much larger variation in risk estimations if fewer risk factors were present. GPs who reported use of guidelines overestimated coronary risk twice as frequently as nonusers of guidelines. Preventive cardiology in general practice is common and the effect of lifestyle intervention is well accepted. Poor discrimination between high- and low-risk patients may, however, lead to suboptimal preventive care. The use of guidelines does not seem to improve risk estimation and further dissemination of better tools for risk estimation is needed.