title: Cardiovascular risk perception and evidence--practice gaps in Australian general practice (the AusHEART study).
abstract: OBJECTIVE
  To examine the perception and management of cardiovascular disease (CVD) risk in Australian primary care.
  
  
  METHODS
  The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey of 322 general practitioners. Each GP was asked to collect data on CVD risk factors and their management in 15-20 consecutive patients aged >or= 55 years who presented between April and June 2008, and to estimate each patient's absolute risk of a cardiovascular event in the next 5 years.
  
  
  METHODS
  Estimated 5-year risk of a cardiovascular event, proportion of patients receiving appropriate treatment.
  
  
  RESULTS
  Among 5293 patients, 29% (1548) had established CVD. A further 22% (1145), when categorised according to the 2009 National Vascular Disease Prevention Alliance guideline, to 42% (2211), when categorised according to National Heart Foundation (NHF) 2004 guideline, had a high (>or= 15%) 5-year risk of a cardiovascular event. Of the 1548 patients with established CVD, 50% were prescribed a combination of a blood pressure (BP)-lowering medication, a statin and an antiplatelet agent, and 9% were prescribed a BP-lowering medication and a statin but not an antiplatelet agent. Among high-risk patients without established CVD, categorised using NHF 2004 adjustments, 34% were prescribed a combination of a BP-lowering medication and a statin. GPs estimated 60% of patients with established CVD as having a risk of less than 15%. The GPs' estimates of risk among patients without established CVD agreed with the centrally calculated estimate (according to the NHF 2004 guideline) in 48% of instances (Kappa = 0.21).
  
  
  CONCLUSIONS
  These data confirm substantial undertreatment of patients who are at high risk of a cardiovascular event. We recommend that GPs assess absolute risk for older patients and ensure that high-risk patients receive evidence-based pharmacotherapy.
authors.affiliation: The George Institute for International Health, Sydney, NSW, Australia. eheeley@george.org.au
authors.forename: Emma L
authors.initials: EL
authors.lastname: Heeley
authors.forename: David P
authors.initials: DP
authors.lastname: Peiris
authors.forename: Anushka A
authors.initials: AA
authors.lastname: Patel
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Andrew
authors.initials: A
authors.lastname: Weekes
authors.forename: Claire
authors.initials: C
authors.lastname: Morgan
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
authors.forename: John P
authors.initials: JP
authors.lastname: Chalmers
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012308:Risk Management
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors