BMJ 1995;310:975-978 (15 April)

General practice

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study

Steven A Grover, director,a Ilka Lowensteyn, research fellow,a Katja L Esrey, research fellow,a Yvonne Steinert, psychologist,b Lawrence Joseph, biostatistician,a Michal Abrahamowicz, biostatistician a

a Division of Clinical Epidemiology, Centre for the Analysis of Cost-Effective Care, Montreal General Hospital, Montreal, Quebec, Canada H3G 1A4, b Department of Family Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2

Correspondence and reprint requests to: Dr Grover.

Abstract

Objective: To evaluate the ability of doctors in primary care to assess risk patients' risk of coronary heart disease.
Design: Questionnaire survey.
Setting: Continuing medical education meetings, Ontario and Quebec, Canada.
Subjects: Community based doctors who agreed to enrol in the coronary health assessment study.
Main outcome measure: Ratings of coronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the "average" 40 year old Canadian man and 70 year old Canadian woman.
Results: 253 doctors answered the questionnaire. For 30 year olds the doctors rated cigarette smoking as the most important risk factor and raised serum triglyceride concentrations as the least important; for 70 year old patients they rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each individual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P<0.001). They showed a strong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. While doctors accurately estimated the relative risk of a specific patient (compared with the average adult) they systematically overestimated the absolute baseline risk of developing coronary disease and the risk reductions associated with specific interventions.
Conclusions: Despite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctors. Additional strategies must be developed to help doctors to assess better their patients' coronary risk.

Key messages

  • Key messages

  • This study shows that doctors in primary care accurately assess the relative risk of coronary disease in individual patients

  • They systematically overestimate, however, the absolute risk of coronary disease in individual patients

  • Doctors in primary care also overestimate the absolute benefits of modification of coronary risk factors including lowering lipid concentration, control of blood pressure, and stopping smoking

  • Additional strategies must be found to improve the skills in risk assessment among doctors in primary care to support their clinical decision making in individual patients


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