High cardiovascular risk and poor adherence to guidelines in 11,069 patients of middle age and older in primary care centres.
BACKGROUND
Evaluation of the risk for fatal cardiovascular (CV) disease and adherence to guidelines in ambulatory patients in primary care centres.


METHODS
Cross-sectional survey of risk factors and 10-year Systematic Coronary Risk Evaluation (SCORE) risk in 11,069 patients aged 50 years or more in primary care.


RESULTS
Three-thousand, seven hundred and thirteen (33.5%) patients were actual smokers. Although 61% of the patients were treated with at least one antihypertensive drug, the mean systolic blood pressure was 141±15 mmHg. Of the treated patients, only 15.9% were at goal. Thirty-six percent of the patients were perceived as normocholesterolemic by the primary care physician. In the group of patients, presumed as hypercholesterolemic, the total cholesterol level was 235±38 mg/dl, suggesting that only very high cholesterol level was considered relevant by physicians. Virtually 0% of the patients (n=2) were treated correctly. Obesity (body mass index >30 kg/m) was found in 41% of the patients and central obesity was found in 50% of the patients. Diabetes was present in 2085 (19%) patients and at least one earlier vascular event was present in 2913 (26.3%) patients, with combined pathologies in 388 (4.5%) patients. In the remaining 6766 (61%) patients (neither diabetes nor earlier CV event), the 10-year fatal CV risk according to the Belgian SCORE table was calculated as follows: 716 (10.6%) patients had a risk of less than 2%; 1680 (24.8%) patients had a risk of 2-4%; 2576 (38%) patients had a risk of 5-9% and 1794 (26.6%) patients had a risk of 10% or more.


CONCLUSIONS
Despite simple, clear, credible guidelines, despite the existence of a simple tool such as SCORE risk scoring and despite a very accessible health system in Belgium, the CV risk remains very high even in a professional medical environment of daily primary care practice.
Missault
Luc
L
Department of Cardiology, St Jan Hospital, Bruges, Belgium. luc.missault@azbrugge.be
Witters
Nadine
N
Imschoot
Johan
J
D000368:Aged; D000553:Ambulatory Care; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001530:Belgium; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016540:Smoking Cessation
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors