Potential use of 10-year and lifetime coronary risk information for preventive cardiology prescribing decisions: a primary care physician survey.
BACKGROUND
Data are sparse regarding how physicians use coronary risk information for prescribing decisions.


METHODS
We presented 5 primary prevention scenarios to primary care physicians affiliated with an academic center and surveyed their responses after they were provided with (1) patient risk factor information, (2) 10-year estimated coronary disease risk information, and (3) 10-year and lifetime risk estimates. We asked about aspirin prescribing, lipid testing, and lipid-lowering drug prescribing.


RESULTS
Of 202 physicians surveyed, 99 (49%) responded. The physicians made guideline-concordant aspirin decisions 51% to 91% of the time using risk factor information alone. Providing 10-year risk estimates increased concordant aspirin prescribing when the 10-year coronary risk was moderately high (15%) and decreased guideline-discordant prescribing when the 10-year risk was low (2 of 4 cases). Providing the lifetime risk information sometimes increased guideline-discordant aspirin prescribing. The physicians selected guideline-concordant thresholds for initiating treatment with lipid-lowering drugs 44% to 75% of the time using risk factor information alone. Selecting too low or too high low-density lipoprotein cholesterol thresholds was common. Ten-year risk information improved concordance when the 10-year risk was moderately high. Providing lifetime risk information increased willingness to initiate pharmacotherapy at low-density lipoprotein cholesterol levels that were lower than those recommended by guidelines when the 10-year risk was low but the lifetime risk was high.


CONCLUSIONS
Providing 10-year coronary risk information improved some hypothetical aspirin-prescribing decisions and improved lipid management when the short-term risk was moderately high. High lifetime risk sometimes led to more intensive prescription of aspirin or lipid-lowering medication. This outcome suggests that, to maximize the benefits of risk-calculating tools, specific guideline recommendations should be provided along with risk estimates.
Persell
Stephen D
SD
Northwestern University, Chicago, IL 60611, USA. spersell@nmff.org
Zei
Charles
C
Cameron
Kenzie A
KA
Zielinski
Michael
M
Lloyd-Jones
Donald M
DM
D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage*; D002309:Cardiology / Q000379:methods / Q000592:standards; D003327:Coronary Disease / Q000517:prevention & control*; D003661:Decision Support Techniques; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000706:statistics & numerical data*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000924:Anticholesteremic Agents; D005343:Fibrinolytic Agents; D008055:Lipids; D001241:Aspirin