Physicians' estimates of the 10 year cardiovascular risk in hypertensive patients: an evaluation in primary care physicians in training.
OBJECTIVE
To evaluate how young physicians in training perceive their patients' cardiovascular risk based on the medical charts and their clinical judgment.


METHODS
Cross sectional observational study.


METHODS
University outpatient clinic, Lausanne, Switzerland.


METHODS
Two hundred hypertensive patients and 50 non-hypertensive patients with at least one cardiovascular risk factor.


METHODS
Comparison of the absolute 10-year cardiovascular risk calculated by a computer program based on the Framingham score and adapted for physicians by the WHO/ISH with the perceived risk as assessed clinically by the physicians.


RESULTS
Physicians underestimated the 10-year cardiovascular risk of their patients compared to that calculated with the Framingham score. Concordance between methods was 39% for hypertensive patients and 30% for non-hypertensive patients. Underestimation of cardiovascular risks for hypertensive patients was related to the fact they had a stabilized systolic blood pressure under 140 mm Hg (OR = 2.1 [1.1; 4.1]).


CONCLUSIONS
These data show that young physicians in training often have an incorrect perception of the cardiovascular risk of their patients with a tendency to underestimate the risk. However, the calculated risk could also be slightly overestimated when applying the Framingham Heart Study model to a Swiss population. To implement a systematic evaluation of risk factors in primary care a greater emphasis should be placed on the teaching of cardiovascular risk evaluation and on the implementation of quality improvement programs.
Senn
Michèle
M
Policlinique Médicale Universitaire, Lausanne, Switzerland.
Favrat
Bernard
B
Vaucher
Paul
P
Burnier
Michel
M
D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007388:Internal Medicine / Q000193:education; D008297:Male; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D011320:Primary Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D013557:Switzerland