Comparison of the impact of cardiovascular guidelines on a working population.
The influence of guidelines is more and more important in the medicine using standardised knowledge as Clinical Practice Guideline (CPG).


OBJECTIVE
1) Determine the impact of different CPGs on a working population 2) Using the Framingham risk calculation as gold standard to check the CPG classifications.


METHODS
This work is done in the context of two hypertension management CPGs published in 1997 and 2000, and one dyslipidemia CPG by the French agency HAS. A French regional study sample of 2817 patients was selected. The results of the classification system by CPG were compared to those given by the chosen gold standard: Framingham cardiovascular risk calculation.


RESULTS
The HBP CPG concerns more of the quarter of the working population. The mean of the cardiovascular risk calculation for the patients with drug treatment is higher than for the patients with no drug treatment and for those not screened by the CPG. Some patients with a very high calculated risk, are not selected by the screening CPG based on too few or on not adequate variables.


CONCLUSIONS
For the two High Blood Pressure Management CPGs, the selected patients are not distributed the same way in the two CPGs. Observed agreement is poor between the two hypertension CPG versions. Screening people for specific health care should be based on risk calculation not on few variables. Feeding back our results to the CPG creator group should reduce the variability of recommendations.
Gillois
Pierre
P
Laboratoire SPIEAO, Faculté de Médecine Nancy I, France.
Claudot
Frédérique
F
Chatellier
Gilles
G
Kohler
François
F
Jaulent
Marie Christine
MC
D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D050171:Dyslipidemias / Q000188:drug therapy; D005260:Female; D005602:France; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*