医生预测冠心病风险的能力。
Physicians' ability to predict the risk of coronary heart disease.
作者信息
Pignone Michael, Phillips Christopher J, Elasy Tom A, Fernandez Alicia
机构信息
Division of General Internal Medicine and Cecil Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA.
出版信息
BMC Health Serv Res. 2003 Jul 11;3(1):13. doi: 10.1186/1472-6963-3-13.
BACKGROUND
Coronary heart disease (CHD) is the leading cause of death in the United States. Previous research examining physicians ability to estimate cardiovascular risk has shown that physicians' generally overestimate the absolute risk of CHD events. This question has, however, only studied risk prediction for a limited number of patient care scenarios. The aim of this study is to measure the ability of physicians to estimate the risk of CHD events in patients with no previous history of coronary heart disease.
METHODS
Twelve primary prevention scenarios with a 5-year risk of CHD events were developed. This questionnaire was surveyed at 3 university teaching hospitals where the participants were a convenience sample of internal medicine residents and fellows or attending physicians in general internal medicine or cardiology. For each scenario, physicians were asked to estimate the baseline 5-year risk of a coronary heart disease event and the revised risk if the patient were to receive lipid-lowering drug therapy. Estimates of the baseline 5-year risk were compared with values calculated from Framingham risk equations. Inaccurate responses were defined as those with a ratio of estimated to actual risk of more than 1.5 or less than 0.67. Physicians' estimates of the relative risk reduction with therapy were considered to be accurate if they were between 25% and 40%.
RESULTS
79 physicians (53 residents, 8 fellows, 18 attending physicians) completed the survey. Only 24% of physicians' risk estimates were accurate. In most cases, physicians overestimated the absolute risk of cardiovascular events without therapy (proportion overestimating ranged from 32-92% for the 12 individual scenarios). Physicians made larger errors in patient scenarios involving patients with high total or LDL cholesterol levels. Physicians' estimates of the relative risk reduction from treatment were more accurate: 43% of estimates were between 25 and 40%. Over 85% of physicians recommended treatment in 10 of 12 scenarios.
CONCLUSIONS
Physicians overestimate the absolute risk of CHD events and the potential absolute benefit of drug therapy.
背景
冠心病（CHD）是美国的主要死因。先前关于医生评估心血管风险能力的研究表明，医生通常高估冠心病事件的绝对风险。然而，这个问题仅在有限数量的患者护理场景中研究了风险预测。本研究的目的是衡量医生评估无冠心病病史患者发生冠心病事件风险的能力。
方法
制定了12个具有5年冠心病事件风险的一级预防场景。该问卷在3所大学教学医院进行调查，参与者是内科住院医师、研究员或普通内科或心脏病学主治医师的便利样本。对于每个场景，要求医生估计冠心病事件的基线5年风险以及患者接受降脂药物治疗后的修正风险。将基线5年风险的估计值与根据弗明汉风险方程计算的值进行比较。不准确的回答定义为估计风险与实际风险之比大于1.5或小于0.67的回答。如果医生对治疗相对风险降低的估计在25%至40%之间，则认为是准确的。
结果
79名医生（53名住院医师、8名研究员、18名主治医师）完成了调查。只有24%的医生风险估计准确。在大多数情况下，医生高估了未经治疗的心血管事件的绝对风险（12个个体场景中高估的比例范围为32%-92%）。医生在涉及总胆固醇或低密度脂蛋白胆固醇水平高的患者场景中犯的错误更大。医生对治疗相对风险降低的估计更准确：43%的估计在25%至40%之间。超过85%的医生在12个场景中的10个中推荐了治疗。
结论
医生高估了冠心病事件的绝对风险和药物治疗的潜在绝对益处。
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