title: Gender disparities in the assessment and management of cardiovascular risk in primary care: the AusHEART study.
abstract: OBJECTIVE
  Studies indicate ongoing gender-based differences in the prevention, detection and management of cardiovascular disease. The aims of this study were to determine whether there are differences in general practitioners' (GPs') perceptions of a patient's cardiovascular risk compared with the patient's estimated risk and in the patient's subsequent medical management according to patient sex.
  
  
  METHODS
  The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey among 322 GPs. Each GP was asked to collect data on cardiovascular disease risk factors and their management in 15-20 consecutive patients (age ≥55 years) who presented between April and June, 2008. They were also asked to estimate each patient's absolute risk of a cardiovascular event in the next five years. The main outcomes were the Adjusted Framingham risk, GP estimated risk and proportion of patients receiving blood pressure-lowering, statin and antiplatelet therapy.
  
  
  RESULTS
  A total of 5293 patients were recruited to the study, of whom 2968 (56%) were women. Among patients without established cardiovascular disease, the level of agreement between the GP estimated risk and the Adjusted Framingham risk was poor (<50%) and was similarly so for men (kappa coefficient 0.18; 95% confidence interval (CI) 0.14-0.21) and women (0.19; 95% CI 0.16-0.22; P homogeneity = 0.57). For patients with established cardiovascular disease, however, women were more likely to be assigned by the GP to a lower risk category (66% vs. 54%, P < 0.001) and less likely to be prescribed combination (blood pressure-lowering, statin and antiplatelet) (44% vs. 56%, P < 0.001) therapy compared with men, even after adjusting for patient age.
  
  
  CONCLUSIONS
  Cardiovascular risk is underrecognized and undertreated in Australian primary care patients, with women apparently disproportionately affected. These findings underscore the importance of initiatives to raise awareness of cardiovascular disease in women.
authors: The George Institute for Global Health, University of Sydney, New South Wales, Australia. fturnbull@georgeinstitute.org.au
authors: Fiona
authors: F
authors: Turnbull
authors: Hisatomi
authors: H
authors: Arima
authors: Emma
authors: E
authors: Heeley
authors: Alan
authors: A
authors: Cass
authors: John
authors: J
authors: Chalmers
authors: Claire
authors: C
authors: Morgan
authors: Anushka
authors: A
authors: Patel
authors: David
authors: D
authors: Peiris
authors: Andrew
authors: A
authors: Weekes
authors: Craig
authors: C
authors: Anderson
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000628:therapy; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors