Reducing risk in coronary artery disease. Are Australian patients in general practice achieving targets? The Coronary Artery Disease in general practice study (CADENCE).
BACKGROUND
The benefits of secondary preventive measures for stable coronary artery disease are well established and risk factor treatment targets are defined.


OBJECTIVE
The aim of this study was to examine Australian general practitioners' (GP) perception and management of risk factors in chronic stable angina patients in primary care.


METHODS
Using a cluster-stratified design, 2031 consecutive stable angina patients were recruited between October 2006 and March 2007 by 207 GP who documented their risk factors and reported if they were optimally controlled.


RESULTS
Among the patients, 93% had objective evidence of coronary artery disease and 63% were male, and mean age was 71 ± 11 years. Based upon national guidelines, recommended targets were achieved in: 60% for blood pressure, 24% for body mass index, 23% for waist circumference, 17% for lipid profiles (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides) and 54% of diabetics for haemoglobin A1c . However, GP perceived risk factors to be 'optimally controlled' in: 86% for blood pressure (kappa statistic (κ) = 0.37), 44% for weight (κ = 0.3), 70% for lipids (κ = 0.20) and 60% for haemoglobin A1c (κ = 0.74).


CONCLUSIONS
In this representative cohort of chronic stable angina patients attending GP, cardiovascular risk factor control was frequently suboptimal despite being perceived as satisfactory by the clinicians. New strategies that raise awareness and address this treatment gap need to be implemented.
School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia. andrea.driscoll@deakin.edu.au
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Driscoll
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Beltrame
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Beauchamp
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Morgan
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Weekes
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Tonkin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors