Stroke, coronary and peripheral artery disease survey on antithrombotic treatment (START IT).
OBJECTIVE
To determine the perception of primary care physicians regarding the risk of subsequent atherothrombotic events in patients with established cardiovascular (CV) disease, and to correlate this perception with documented antithrombotic therapy.


METHODS
In a cross-sectional study of the general practice population in Switzerland, 381 primary care physicians screened 127 040 outpatients during 15 consecutive workdays in 2006. Perception of subsequent atherothrombotic events in patients with established CV disease was assessed using a tick box questionnaire allowing choices between low, moderate, high or very high risk. Logistic regression models were used to determine the relationship between risk perception and antithrombotic treatment.


RESULTS
Overall, 13 057 patients (10.4%) were identified as having established CV disease and 48.8% of those were estimated to be at high to very high risk for subsequent atherothrombotic events. Estimated higher risk for subsequent atherothrombotic events was associated with a shift from aspirin monotherapy to clopidogrel, vitamin K antagonist or aspirin plus clopidogrel (p <0.001 for trend). Clopidogrel (12.7% vs 6.8%, p <0.001), vitamin K antagonist (24.5% vs 15.6%, p <0.001) or aspirin plus clopidogrel (10.2% vs 4.2%, p <0.001) were prescribed in patients estimated to be at high to very high risk more often than in those at low to moderate risk.


CONCLUSIONS
Perception of primary care physicians regarding risk of subsequent atherothrombotic events varies in patients with CV disease, and as a result antithrombotic therapy is altered in patients with anticipated high to very high risk even though robust evidence and clear guidelines are lacking.
Keo
Hong H
HH
Swiss Cardiovascular Center, Division of Angiology, Inselspital, Bern University Hospital, Bern, Switzerland.
Warncke
Cornelius
C
Hess
Lorenzo
L
Diehm
Nicolas
N
Do
Dai-Do
DD
Baumgartner
Iris
I
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000209:etiology; D011320:Primary Health Care; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013557:Switzerland
D005343:Fibrinolytic Agents