Awareness and attitudes towards total cardiovascular disease risk assessment in clinical practice among physicians in Southern Nigeria
Keywords:
Risk assessment, cardiovascular disease, and primary preventionAbstract
Objective: This study set out to determine the awareness, use, and attitudes regarding total CVD risk assessment in clinical practice among physicians in Port Harcourt, Nigeria.
Methods: a cross-sectional survey of 150 physicians in government hospitals and private practices in Port Harcourt city. The characteristics of ‘users’ versus ‘non-users’ of CVD risk assessment were compared with the Chi-Square test of significance.
Results: 106 physicians completed the questionnaires. 74 (69.8%) reported awareness of tools available to assess total CVD risk. Among those aware, 87.1% agreed that CVD risk assessment is useful, 81% agreed it improves patient care, 74.3% agreed it leads to better decisions about recommending preventive therapies and 60% agreed that it increased the likelihood that they would recommend risk-reducing therapies to high-risk patients. However, 62.9% of these physicians felt it was time-wasting to use and only 21 (28.4%) actually use CVD risk assessment regularly in practice. The most commonly reported barrier was unfamiliarity with how to use risk estimation tools (52.8%). Majority who use it do so to guide preventive therapy. Female sex and the use of an Internet-enabled smartphone were associated with increased odds of being a ‘user’ of risk estimation tools (odds ratios 4.8, CI 1.4-16.9; and 5.9, CI 1.7-20.0 respectively).
Conclusion: Utilization of risk assessments in clinical practice is low. A major barrier was non-familiarity with how to use the tools. Continuous medical education and wider use of smartphone technology may represent health system approaches to tackling this issue.
References
Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012; 33(13):1635-1701.
Naghavi M, Wang H, Lozano R, et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2014; 385(9963):117-171. doi: 10.1016/S0140-6736(14)61682-2.
Fuster V, Kelly BB, Vedanthan R. Promoting global cardiovascular health: moving forward. Circulation 2011; 123:1671-1678.
WHO Regional Committee for Africa. Cardiovascular diseases in the African region: current situation and perspectives-report of the regional director 2005. Available online: http://www.afro.who.int/rc55/documents/afr_rc55_12_cardiovascular.pdf
Rose G. Strategy of prevention: lessons from cardiovascular disease. BMJ. 1981; 282: 1847-1851.
JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91:1-52.
Mendis S, Lindholm LH, Mancia G, et al. World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries. J Hypertens 2007; 25(8):1578-1582.
Eaton CB, Galliher JM, McBride PE, et al. Family physician's knowledge, beliefs, and self-reported practice patterns regarding hyperlipidemia: a National Research Network (NRN) survey. J Am Board Fam Med 2006;19:46-53.
Oriol-Zerbe C, Abholz HH. Primary prevention of cardiovascular diseases by lipid-lowering treatment in German general practice: results from GPs ignoring guidelines and risk calculators. Eur J Gen Pract 2007;13:27-34.
Graham IM, Stewart M, Hertog MG. Factors impeding the implementation of cardiovascular prevention guidelines: findings from a survey conducted by the European Society of Cardiology. Eur J Cardiovasc Prev Rehabil 2006;13:839-45
Shillinglaw B, Viera AJ, Edwards T, et al. Use of global coronary heart disease risk assessment in practice: a cross-sectional survey of a sample of U.S. physicians. BMC Health Services Research 2012; 12:20 Available from http://www.biomedcentral.com/1472-6963/12/20
Cooper A, O’Flynn N. Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance. BMJ 2008; 336(7655):1246-1248.
Brindle P, Beswick A, Fahey T, et al. Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review. Heart. 2006;92(12):1752-1759. doi:10.1136/hrt.2006.087932.
Sheridan SL, Crespo E. Does the routine use of global coronary heart disease risk scores translate into clinical benefits or harms? A systematic review of the literature. BMC Health Serv Res. 2008;860.
Imms A, Quinn S, Nelson M. General practitioners’ use of cardiovascular risk calculators. Australian Family Physician 2010; 39(1). Available from http://www.racgp.org.au/download/documents/AFP/2010/Jan-Feb/201001imms.pdf
Gaziano TA, Young CR, Fitzmaurice G, et al. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. The Lancet 2008;371(9616):923-931.
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