Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: The PERCRO-DOC survey
Introduction
Cardiovascular diseases (CVD) are the leading cause of death and the disease burden worldwide. In Europe they cause 43% of all the deaths before the age of 75 in women and 38% of deaths in men, not only in high- but more and more in low- and middle-income countries as well [1]. This means that one in 3 of all men and two in 5 of all women die from these diseases before the age of 75. Most important among these diseases are coronary heart disease (CHD), acute myocardial infarction (AMI) and ischaemic stroke. Over the past 25 years death rates from CVD have been falling in most northern and western European countries (precisely EU members before 2004 or “old EU “) but rising rapidly in most central and especially eastern European countries [2], [3]. However, the decrease in mortality in mentioned countries has not been accompanied by reductions in CVD morbidity.
It is well known that CVD are all product of multiple risk factors, the most important being dyslipidemias (particularly increased blood concentrations of total and LDL-cholesterol and triglycerides and decreased HDL-cholesterol), elevated blood pressure, smoking, overweight and obesity, diabetes and metabolic syndrome [4]. Numerous studies have confirmed that almost all of these risk factors are modifiable and therefore most of CVD are preventable [5], [6].
However, despite clear evidence of the benefits of modifiable risk factors management, especially in patients with CVD and other high-risk patients who are defined as the highest priority for prevention by all versions of Joint European guidelines on CVD prevention [4], [7], [8], [9] as well as by all the other non-European guidelines [10], [11], the results of surveys performed for monitoring the trends in risk factor management are quite disappointing [12]. Recently published results of the EUROASPIRE studies designed to follow these trends during the last 10 years in different European countries have also shown a collective medical failure to achieve the risk factor targets according to the guidelines in this priority group. According to them about one-fifth of CHD patients still continue to smoke, their body weight continues to increase as well as the prevalence of central obesity, the prevalence of diabetes also continues to increase and the therapeutic control of diabetes remains poor while the blood pressure management shows no improvement despite the increases in prescriptions for all classes of anti-hypertensive medications except for calcium channel blockers [13], [14]. Only the management of dyslipidemia has substantially improved driven by the widespread use of statins but significant number of patients on lipid-lowering therapy is still not achieving the treatment goals according to the guidelines [15].
The objective of this survey was to explore the physicians’ perception of CVD risk factors and their adherence to different international prevention guidelines with the idea to try to explain the inadequate and delayed translation of scientific evidence as presented in guidelines into clinical practice. Since only few studies on physicians’ knowledge and perceptions on CVD risk factors and guidelines implementation have been published so far, we have performed the following survey on the attitudes of the general practitioners/family doctors, internists and cardiologists with regard to their knowledge of guidelines and perception of CVD risk factors as well as to assess their treatment practices and the impact of their knowledge on their treatment practices – PERception of CVD risk factors in CROatia – DOCtors (PERCRO-DOC survey).
Section snippets
Study population and questionnaire
We conducted a cross-sectional questionnaire survey of primary care physicians defined as general practitioners and/or family doctors (GP), and specialists—internists, and cardiologists in Croatia, a country with 11 799 physicians (1753 GPs and 927 specialists in GP, 987 general internists, 203 cardiologists) and 4 400 000 inhabitants [16]. Physicians were randomly recruited using national physicians registry and professional societies’ directories. The country was divided into five geo-economic
Results
1382 physicians consented to answer the questionnaire and their answers were included in this survey. 618 (44.7%) were GPs, 312 (22.6%) family medicine specialists, 165 (11.9%) cardiologists and 213 (15.4%) internists. Since 74 (5.4%) did not answer the question about their speciality status, their answers were not included in comparing knowledge and attitudes by specialities. For further analysis GPs and family medicine specialists were taken together as primary practice physicians.
Most of
Discussion
This is the largest survey on physician awareness of risk factors and adherence to CVD prevention guidelines performed so far. Only three similar surveys were performed previously: on 754 randomly selected GPs and family doctors from five European countries by telephone interviews in 2001—REACT survey [17], on 664 general practitioners and internists by mailed questionnaire in the city of Muenster, Germany in 2002 [18] and a market research survey on 220 primary care physicians and
Conclusion
An important and encouraging observation from this survey is that the majority of physicians support the concept of preventive cardiology and guidelines use. However, this survey also showed the reality that only half of them use guidelines in everyday practice and too many of them do not know, for example, the target values for lipids according to the guidelines. It seems that most physicians would like to have simpler, more user-friendly guidelines evidence-based upon independent research in
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