Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease.
OBJECTIVE
To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy.


METHODS
Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and tertiary prevention studies of coronary artery bypass surgery for chronic stable angina with left main coronary stenosis.


METHODS
Nationally representative sample of 599 practicing family physicians, general internists, and cardiologists selected from the American Medical Association masterfile. Among eligible physicians, 84 (44%) of 191 family physicians, 77 (40%) of 194 general internists, and 66 (34%) of 194 cardiologists responded.


METHODS
Estimates of risk at baseline and after therapy, and whether therapy generally would be recommended.


RESULTS
For both primary prevention case simulations (scenarios), cardiologists provided lower, more accurate estimates of baseline cardiovascular risk and of absolute therapeutic benefit than either family physicians or general internists. The range of the generalists' estimates was extremely wide. Perceptions of relative risk reduction and treatment recommendations for the primary prevention scenarios did not differ among specialties. Overall, generalists who would not recommend primary preventive therapy in these scenarios appeared to give more accurate estimates than did generalists who would recommend such therapy.


CONCLUSIONS
Many generalists have inflated perceptions of cardiovascular risk without treatment and of the benefit of risk-modifying medical treatment. Further study should assess the reasons for these misperceptions and their effect on counseling about primary preventive therapy.
Friedmann
P D
PD
Deaconess Hospital, Boston, Massachusetts, USA.
Brett
A S
AS
Mayo-Smith
M F
MF
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000601:surgery; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D003430:Cross-Sectional Studies; D005194:Family Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007388:Internal Medicine; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires