Does detection of carotid plaque affect physician behavior or motivate patients?
Does detection of carotid plaque affect physician behavior or motivate patients?
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DOI：
10.1016/j.ahj.2007.06.046
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发表时间：
2007-12-01
影响因子：
4.8
通讯作者：
Stein, James H.
中科院分区：
文献类型：
--
作者：
Wyman, Rachael A.;Gimelli, Giorgio;Stein, James H.
影像学技术用于识别亚临床动脉粥样硬化正变得越来越普遍，但关于其对患者或医生行为的影响的数据很少。我们评估了超声筛查的影响，以确定颈动脉斑块对医生的治疗计划和patient motivation.Methods的主题包括无症状的患者没有已知的血管疾病谁有2个或更多的心脏危险因素。在办公室环境中使用手持式超声设备对左右颈动脉进行环形扫描以识别颈动脉斑块。在颈动脉扫描结果报告之前和之后评估医生的初步治疗建议。受试者在提供扫描结果之前和之后完成了一项调查，以评估改变生活方式的动机。结果在9个月内招募了50名受试者。他们的平均（SD）年龄为54.0（10.4）岁，平均10年心血管风险为7.8%（7.9%）。超过一半（58%）的受试者至少有一个颈动脉斑块。当发现颈动脉斑块时，医生更可能开阿司匹林（P = 0.031）和降脂治疗（P = 0.004）。虽然颈动脉斑块的受试者报告;增加他们认为的可能性发展为心脏病（P = .013），他们没有报告增加的动机，使生活方式changes.Conclusions超声筛查颈动脉斑块在办公室设置可以改变医生的治疗计划。尽管斑块的存在增加了患者对心血管风险的感知，但它并没有促使患者改变生活方式。
Background Imaging techniques to identify subclinical atherosclerosis are becoming more widespread, but few data exist regarding their influence on patient or physician behavior. We evaluated the impact of ultrasound screening to identify carotid artery plaques on physician treatment plans and patient motivation.Methods Subjects included asymptomatic patients without known vascular disease who had 2 or more cardiac risk factors. Circumferential scanning of the right and left carotid arteries to identify carotid plaques was performed using a handheld ultrasound device in an office setting. The physician's initial treatment recommendations were assessed before and after the results of the carotid,scan were reported. Subjects completed a survey to assess motivation to make lifestyle changes before and after the results of the scan were provided.Results Fifty subjects were enrolled over 9 months. Their mean (SD) age was 54.0 (10.4) years and their mean Framingham 10-year cardiovascular risk was 7.8% (7.9%). More than half (58%) of the subjects had at least one carotid plaque. When carotid plaque was identified, physicians were more likely to prescribe aspirin (P = .031) and lipid-lowering therapy (P = .004). Although subjects with carotid plaque reported an;Increase in their perceived likelihood of developing heart disease (P = .013), they did not report increased motivation to make lifestyle changes.Conclusions Ultrasound screening for carotid plaque in an office setting can alter physician treatment plans. Although the presence of plaque increased patient perception of cardiovascular risk, it did not motivate patients to make lifestyle changes.