澳大利亚全科医疗中的心血管风险感知与证据-实践差距（AusHEART 研究）。

Cardiovascular risk perception and evidence--practice gaps in Australian general practice (the AusHEART study).

机构信息

The George Institute for International Health, Sydney, NSW, Australia.

出版信息

Med J Aust. 2010 Mar 1;192(5):254-9. doi: 10.5694/j.1326-5377.2010.tb03502.x.

DOI:10.5694/j.1326-5377.2010.tb03502.x

PMID:20201758

Abstract

OBJECTIVE

To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care.

DESIGN, SETTING AND PARTICIPANTS: The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey of 322 general practitioners. Each GP was asked to collect data on CVD risk factors and their management in 15-20 consecutive patients aged >or= 55 years who presented between April and June 2008, and to estimate each patient's absolute risk of a cardiovascular event in the next 5 years.

MAIN OUTCOME MEASURES

Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment.

RESULTS

Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (>or= 15%) 5-year risk of a cardiovascular event. Of the 1548 patients with established CVD, 50% were prescribed a combination of a blood pressure (BP)-lowering medication, a statin and an antiplatelet agent, and 9% were prescribed a BP-lowering medication and a statin but not an antiplatelet agent. Among high-risk patients without established CVD, categorised using NHF 2004 adjustments, 34% were prescribed a combination of a BP-lowering medication and a statin. GPs estimated 60% of patients with established CVD as having a risk of less than 15%. The GPs' estimates of risk among patients without established CVD agreed with the centrally calculated estimate (according to the NHF 2004 guideline) in 48% of instances (Kappa = 0.21).

CONCLUSIONS

These data confirm substantial undertreatment of patients who are at high risk of a cardiovascular event. We recommend that GPs assess absolute risk for older patients and ensure that high-risk patients receive evidence-based pharmacotherapy.

摘要

目的

研究澳大利亚初级保健中对心血管疾病（CVD）风险的认知和管理。

设计、地点和参与者：澳大利亚高血压和绝对风险研究（AusHEART）是一项全国代表性、聚类分层、横断面调查，共纳入 322 名全科医生。每位全科医生被要求在 2008 年 4 月至 6 月期间收集 15-20 名连续就诊的年龄≥55 岁的 CVD 风险因素及其管理数据，并估计每位患者未来 5 年内发生心血管事件的绝对风险。

主要观察指标

估计未来 5 年内发生心血管事件的风险，接受适当治疗的患者比例。

结果

在 5293 名患者中，29%（1548 名）患有已确诊的 CVD。另有 22%（1145 名）根据 2009 年国家血管疾病预防联盟指南分类，42%（2211 名）根据国家心脏基金会（NHF）2004 年指南分类，具有较高（≥15%）的未来 5 年内发生心血管事件的风险。在 1548 名患有已确诊 CVD 的患者中，50%接受了降压药物、他汀类药物和抗血小板药物的联合治疗，9%接受了降压药物和他汀类药物但未接受抗血小板药物的治疗。在未患有 CVD 的高危患者中，根据 NHF 2004 调整分类，34%接受了降压药物和他汀类药物的联合治疗。全科医生估计 60%的已确诊 CVD 患者的风险低于 15%。全科医生对无 CVD 患者的风险估计与中央计算的估计（根据 NHF 2004 指南）在 48%的情况下相符（Kappa = 0.21）。