Research Activities, August 2010: Outcomes/Effectiveness Research: Coronary risk information may improve prescribing practices

Outcomes/Effectiveness Research
Coronary risk information may improve prescribing practices
Calculating a person's 10-year and lifetime risk for developing heart disease can guide the physician on how to use aspirin and cholesterol-lowering drugs, suggests a new study. Researchers received survey information from 99 primary care physicians practicing within an academic medical center. They each received five patient scenarios that included details on cardiovascular risk factors as well as 10-year and lifetime risk estimates for developing heart disease. Physicians were asked about how they would prescribe aspirin and cholesterol-lowering drugs for each scenario.

Using risk-factor information alone, the physicians made appropriate aspirin therapy decisions 51 to 91 percent of the time. They often recommended aspirin when the short-term risk was low. Appropriate aspirin prescribing rose when they factored in 10-year risk estimates that indicated a moderately high coronary risk. Lifetime risk information tended to make physicians overtreat with aspirin. However, 20 percent did not recommend aspirin therapy in one scenario where a male patient had a 10-year risk of 15 percent (moderately high).

Risk-factor information alone produced guideline-appropriate decisions for starting cholesterol-lowering drugs 44 to 75 percent of the time. However, it was common for physicians to select too low or too high cutoffs for LDL-cholesterol levels to initiate treatment. Having 10-year risk information improved the ability to use proper cholesterol level limits when the risk was moderately high. High lifetime risk information prompted the physicians to prescribe cholesterol-lowering drugs for LDL-levels lower than those recommended when the 10-year risk was low but the lifetime risk was high. The researchers suggest that to maximize the benefits of risk-calculating tools, specific guideline recommendations should be provided along with risk estimates. The study was supported in part by the Agency for Healthcare Research and Quality (HS15647).

See "Potential use of 10-year and lifetime coronary risk information for preventive cardiology prescribing decisions," by Stephen D. Persell, M.D., M.P.H., Charles Zei, Kenzie A. Cameron, Ph.D., M.P.H., and others in the March 8, 2010, Archives of Internal Medicine 170(5), pp. 470-477.

Research Activities, August 2010: Outcomes/Effectiveness Research: Coronary risk information may improve prescribing practices