Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease
Differences in generalists' and cardiologists' perceptions of cardiovascular risk and the outcomes of preventive therapy in cardiovascular disease
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DOI：
10.7326/0003-4819-124-4-199602150-00005
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发表时间：
1996-02-15
影响因子：
39.2
通讯作者：
MayoSmith, MF
中科院分区：
文献类型：
--
作者：
Friedmann, PD;Brett, AS;MayoSmith, MF
目的：为了比较通才和心脏病专家对基线心血管风险和预防性治疗结果的估计，设计：使用来自高胆固醇血症和单纯收缩期高血压的一级预防试验的典型患者的书面病例模拟的横断面邮件调查，以及慢性稳定型心绞痛伴左主干冠状动脉狭窄的冠状动脉旁路手术的三级预防研究，参与者：从美国医学会主文件中选择的599名执业家庭医生、普通内科医生和心脏病专家的全国代表性样本。在符合条件的医生中，191名家庭医生中有84名（44%），194名普通内科医生中有77名（40%），194名心脏病专家中有66名（34%）做出了回答。测量：基线和治疗后的风险估计，以及是否推荐治疗。对于初级预防病例模拟（场景），心脏病专家提供了较低，比家庭医生或普通内科医生更准确地估计基线心血管风险和绝对治疗获益。通才们的估计范围极广。相对风险降低的看法和治疗建议的一级预防方案没有不同的专业。总体而言，通才谁不会建议在这些情况下的主要预防治疗似乎给更准确的估计比通才谁会建议such therapy.Conclusions：许多通才夸大了心血管疾病的风险，没有治疗和风险修改的医疗治疗的好处的看法。进一步的研究应该评估这些误解的原因及其对初级预防治疗咨询的影响。
Objective: To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy.Design: Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and tertiary prevention studies of coronary artery bypass surgery for chronic stable angina with left main coronary stenosis,Participants: Nationally representative sample of 599 practicing family physicians, general internists, and cardiologists selected from the American Medical Association masterfile. Among eligible physicians, 84 (44%) of 191 family physicians, 77 (40%) of 194 general internists, and 66 (34%) of 194 cardiologists responded.Measurements: Estimates of risk at baseline and after therapy, and whether therapy generally would be recommended.Results: For both primary prevention case simulations (scenarios), cardiologists provided lower, more accurate estimates of baseline cardiovascular risk and of absolute therapeutic benefit than either family physicians or general internists. The range of the generalists' estimates was extremely wide. Perceptions of relative risk reduction and treatment recommendations for the primary prevention scenarios did not differ among specialties. Overall, generalists who would not recommend primary preventive therapy in these scenarios appeared to give more accurate estimates than did generalists who would recommend such therapy.Conclusions: Many generalists have inflated perceptions of cardiovascular risk without treatment and of the benefit of risk-modifying medical treatment. Further study should assess the reasons for these misperceptions and their effect on counseling about primary preventive therapy.