GP management of patients with cardiovascular disease “suboptimal”

By Michael Woodhead

7 Oct 2020

Patients with cardiovascular disease (CVD) are not receiving guideline-recommended treatments such as statins and antihypertensives from their GP, an Australian study has found.

In a review of 2015-2018 data for 10,631 primary care patients with established CVD, researchers at the University of Notre Dame in Sydney found that only 57% of had been prescribed the treatments recommended in 2012 CVD treatment guidelines.

Based on absolute cardiovascular risk, the guidelines recommend medications including statins, antihypertensives and antiplatelet agents for patients with cardiovascular disease (defined as coronary heart disease, cerebrovascular disease, peripheral vascular disease, left ventricular hypertrophy, atrial fibrillation, or heart failure).

But for these patients, 20.1% received no risk-lowering medications whatsoever, 12.6% received only blood pressure lowering medication and 10.5% received only a lipid-lowering medication.

Only 38.7% patients achieved clinical targets for blood pressure and 53.1% achieved targets for LDL-cholesterol levels.

And for almost 16,000 patients identified with a high estimated of CVD risk (defined as BP < 140/90 mmHg; established cardiovascular disease or diabetes: < 130/80 mmHg) only 41% received all guideline recommended treatments, according to the study findings  published in the MJA.

For patients at CVD risk, 57.1% had achieved blood pressure targets and 36.3% achieved  LDL-C targets.

“Our findings indicate that primary care management of patients with CVD is sub-optimal,” said lead investigator Associate Professor Charlotte Hespe, Head of General Practice and General Practice Research at the university.

“Adopting the absolute risk assessment approach has not improved adherence to management guidelines, similar to the experience in Europe, Canada, and the UK,” she added.

“GPs play essential roles in identifying patients at risk of CVD and managing their treatment, but ensuring their adherence to evidence-based recommendations is challenging,” the researchers said.

“While risk assessment tools are important, overcoming patient, GP, and health system barriers to changes in care delivery will be critical to progress.”

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