title: Inaccurate risk perceptions contribute to treatment gaps in secondary prevention of cardiovascular disease.
abstract: BACKGROUND
  All patients with cardiovascular disease (CVD) are at high risk of recurrent events. Despite strong evidence, large treatment gaps exist in CVD secondary prevention. We hypothesise that patients' self-perception and general practitioner's (GP) assessment of future cardiovascular (CV) risk may influence secondary prevention behaviours.
  
  
  OBJECTIVE
  To examine in patients with known CVD the perceived risk of future CV events and its relationship with use of secondary prevention medications and risk factor control.
  
  
  METHODS
  We examined patient and practitioner's perceived risk and its relationship with the uptake of secondary prevention recommendations in adults with CVD participating in the Australian Hypertension and Absolute Risk Study.
  
  
  RESULTS
  Among the 1453 participants, only 11% reported having a high absolute risk and 29% reported high relative risk of recurrent events. The GP categorised only 30% as having a 5-year risk ≥15%. After adjusting for covariates, hospitalisation within the preceding 12 months was the only significant predictor of patients' accurate risk perception. Conventional CV risk factors were predictive of the GP's risk estimates. Patients who accurately understood their risk reported higher smoking cessation rates (7 vs 3%, P = 0.003) and greater use of antiplatelet, blood pressure lowering therapy and statins (P ≤ 0.01). However, there was no relationship between GP's risk perception and secondary prevention treatments.
  
  
  CONCLUSIONS
  Both patients and GP have optimistic bias and underestimate the risk of future CV events. Patients' accurate self-perception, but not GP risk perception, was associated with improved secondary preventative behaviours. This suggests that helping patients to understand their risk may influence their motivation towards secondary prevention. Providing support to GP or programmes to help patients better understand their risks could have potential benefit on secondary prevention behaviours.
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Thakkar
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: E L
authors.initials: EL
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, Sydney, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.|Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012649:Self Concept; D016896:Treatment Outcome
keywords: cardiovascular diseases; risk perception; secondary prevention