Physicians’ perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: The PERCRO-DOC survey

Abstract

Background

Cardiovascular diseases (CVD) are the major cause of premature death in the world. This study was designed to examine the physicians’ knowledge and perception of CVD risk factors and perceived implementation of CVD prevention guidelines as well as barriers to their implementation.

Methods

A questionnaire survey by face-to-face interviews was performed among 1382 randomly selected physicians (general practitioners/family medicine specialists, internists and cardiologists) from different regions of Croatia.

Results

Most physicians believe that guidelines are useful but only 56.9% are really using some guidelines. 40.2% favour Joint European guidelines. More primary care physicians use their own personal experience in prevention while internists and cardiologists tend more to use the guidelines. 80.6% believe that they treat their patients with dyslipidemia well but only 53.3% knew the LDL-cholesterol goal value for high-risk patients and only 56.2% knew which HDL-cholesterol level is the marker of increased risk. Hypertension was perceived as the most important risk factor, particularly by primary care physicians, while cardiologists tend to favour diabetes. Although most physicians considered the lack of financial resources as the main barrier in CVD prevention, at the same time most of them believe that it could primarily be improved by better patient education.

Conclusions

Although most physicians support the guidelines use, only half of them use them and in average their knowledge of guidelines is not satisfactory. This is, together with the lack of time and finances and perceived lack of patients’ awareness, probably one of the main causes why they do not manage risk factors better.

Introduction

Cardiovascular diseases (CVD) are the leading cause of death and the disease burden worldwide. In Europe they cause 43% of all the deaths before the age of 75 in women and 38% of deaths in men, not only in high- but more and more in low- and middle-income countries as well [1]. This means that one in 3 of all men and two in 5 of all women die from these diseases before the age of 75. Most important among these diseases are coronary heart disease (CHD), acute myocardial infarction (AMI) and ischaemic stroke. Over the past 25 years death rates from CVD have been falling in most northern and western European countries (precisely EU members before 2004 or “old EU “) but rising rapidly in most central and especially eastern European countries [2], [3]. However, the decrease in mortality in mentioned countries has not been accompanied by reductions in CVD morbidity.

It is well known that CVD are all product of multiple risk factors, the most important being dyslipidemias (particularly increased blood concentrations of total and LDL-cholesterol and triglycerides and decreased HDL-cholesterol), elevated blood pressure, smoking, overweight and obesity, diabetes and metabolic syndrome [4]. Numerous studies have confirmed that almost all of these risk factors are modifiable and therefore most of CVD are preventable [5], [6].

However, despite clear evidence of the benefits of modifiable risk factors management, especially in patients with CVD and other high-risk patients who are defined as the highest priority for prevention by all versions of Joint European guidelines on CVD prevention [4], [7], [8], [9] as well as by all the other non-European guidelines [10], [11], the results of surveys performed for monitoring the trends in risk factor management are quite disappointing [12]. Recently published results of the EUROASPIRE studies designed to follow these trends during the last 10 years in different European countries have also shown a collective medical failure to achieve the risk factor targets according to the guidelines in this priority group. According to them about one-fifth of CHD patients still continue to smoke, their body weight continues to increase as well as the prevalence of central obesity, the prevalence of diabetes also continues to increase and the therapeutic control of diabetes remains poor while the blood pressure management shows no improvement despite the increases in prescriptions for all classes of anti-hypertensive medications except for calcium channel blockers [13], [14]. Only the management of dyslipidemia has substantially improved driven by the widespread use of statins but significant number of patients on lipid-lowering therapy is still not achieving the treatment goals according to the guidelines [15].

The objective of this survey was to explore the physicians’ perception of CVD risk factors and their adherence to different international prevention guidelines with the idea to try to explain the inadequate and delayed translation of scientific evidence as presented in guidelines into clinical practice. Since only few studies on physicians’ knowledge and perceptions on CVD risk factors and guidelines implementation have been published so far, we have performed the following survey on the attitudes of the general practitioners/family doctors, internists and cardiologists with regard to their knowledge of guidelines and perception of CVD risk factors as well as to assess their treatment practices and the impact of their knowledge on their treatment practices – PERception of CVD risk factors in CROatia – DOCtors (PERCRO-DOC survey).