Wolfram Roswitha M, Budinsky Alexandra C, Husslein Peter, Hoppichler Friedrich, Kritz Harald, Sinzinger Helmut
Department of Angiology, University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2002 Sep 30;114(17-18):773-80.
In industrialised countries, coronary heart- (CHD) and other atherosclerosis-associated diseases (AAD) are, with an increasing incidence, responsible for almost half of the deaths among their respective populations. There is unequivocal evidence that medicine should try to achieve a reduction in manifestations of atherosclerosis by efficient preventive strategies. A variety of guidelines have been published during the last decades; nevertheless there is a gap between established recommendations and its application in everyday practice by Austrian physicians. The aim of this survey was to investigate physicians' knowledge of and attitude towards risk factors, preventive strategies and therapy of CHD and other AAD.
The self-administered questionnaire was mailed to 1000 physicians. We obtained an answer from a total of 286 physicians (general practitioners, GP) and specialists in internal medicine, IMS), who were asked about selected items concerning CHD and other AAD and an eventual modification in attitude towards diagnosis and treatment according to their own, personal risk profile.
Risk factors for developing AAD such as elevated CH was identified in 77% (74% GP vs. 84% IMS), hypertension in 77% (76% GP vs. 81% IMS), elevated TG in 37% (40% GP vs. 26% IMS), excess alcohol consumption in 14% of all interrogated physicians (16% GP vs. 9% IMS) respectively. 77% (75% GP vs. 81% IMS) of the physicians considered the CH/HDL-ratio to be important in primary prevention and 83% (81% GP vs. 87% IMS) in secondary prevention; Lipoprotein(a) was considered important in only 9% (8% GP vs. 14% IMS) and 24% (19% GP vs. 41% IMS), respectively.
In summary, all mentioned risk factors were heavily underestimated by Austrian physicians, partly leading to insufficient evaluation and therapeutic interventions. Secondary prevention was managed quite satisfactorily by both GP and IMS according to the Austrian guidelines. The knowledge about primary prevention strategies was significantly worse in GP compared to IMS. There is still a great need for information and training-programs for Austrian physicians to make primary and secondary prevention strategies work more effectively.
在工业化国家，冠心病（CHD）和其他动脉粥样硬化相关疾病（AAD）的发病率不断上升，在各自人群的死亡原因中占近一半。有明确证据表明，医学应通过有效的预防策略来降低动脉粥样硬化的表现。在过去几十年中已经发布了各种指南；然而，奥地利医生在既定建议与其在日常实践中的应用之间仍存在差距。本次调查的目的是调查医生对冠心病和其他AAD的危险因素、预防策略及治疗的了解程度和态度。
将自填式问卷邮寄给1000名医生。我们共收到286名医生（全科医生，GP）和内科专家（IMS）的回复，他们被问及有关冠心病和其他AAD的选定项目，以及根据他们自己的个人风险状况对诊断和治疗态度的最终改变。
分别有77%（全科医生为74%，内科专家为84%）的医生识别出动脉粥样硬化相关疾病发展的危险因素如胆固醇升高，77%（全科医生为76%，内科专家为81%）识别出高血压，37%（全科医生为40%，内科专家为26%）识别出甘油三酯升高，在所有接受询问的医生中，分别有14%（全科医生为16%，内科专家为9%）识别出过量饮酒。77%（全科医生为75%，内科专家为81%）的医生认为胆固醇/高密度脂蛋白比值在一级预防中很重要，83%（全科医生为81%，内科专家为87%）的医生认为在二级预防中很重要；脂蛋白（a）分别仅在9%（全科医生为8%，内科专家为14%）和24%（全科医生为19%，内科专家为41%）的医生中被认为很重要。
总之，奥地利医生严重低估了所有上述危险因素，部分导致评估和治疗干预不足。根据奥地利指南，全科医生和内科专家对二级预防的管理相当令人满意。与内科专家相比，全科医生对一级预防策略的了解明显较差。仍非常需要为奥地利医生提供信息和培训项目，以使一级和二级预防策略更有效地发挥作用。
