TY  - JOUR
T1  - Potential use of 10-year and lifetime coronary risk information for preventive cardiology prescribing decisions: A primary care physician survey
AU  - Persell SD, Zei C, Cameron KA, Zielinski M, Lloyd-Jones DM
Y1  - 2010/03/08
N1  - 10.1001/archinternmed.2009.525
JO  - Archives of Internal Medicine
SP  - 470
EP  - 477
VL  - 170
IS  - 5
N2  - Background 
    Data are sparse regarding how physicians use coronary risk information for prescribing decisions.Methods 
    We presented 5 primary prevention scenarios to primary care physicians affiliated with an academic center and surveyed their responses after they were provided with (1) patient risk factor information, (2) 10-year estimated coronary disease risk information, and (3) 10-year and lifetime risk estimates. We asked about aspirin prescribing, lipid testing, and lipid-lowering drug prescribing.Results 
    Of 202 physicians surveyed, 99 (49%) responded. The physicians made guideline-concordant aspirin decisions 51% to 91% of the time using risk factor information alone. Providing 10-year risk estimates increased concordant aspirin prescribing when the 10-year coronary risk was moderately high (15%) and decreased guideline-discordant prescribing when the 10-year risk was low (2 of 4 cases). Providing the lifetime risk information sometimes increased guideline-discordant aspirin prescribing. The physicians selected guideline-concordant thresholds for initiating treatment with lipid-lowering drugs 44% to 75% of the time using risk factor information alone. Selecting too low or too high low-density lipoprotein cholesterol thresholds was common. Ten-year risk information improved concordance when the 10-year risk was moderately high. Providing lifetime risk information increased willingness to initiate pharmacotherapy at low-density lipoprotein cholesterol levels that were lower than those recommended by guidelines when the 10-year risk was low but the lifetime risk was high.Conclusions 
    Providing 10-year coronary risk information improved some hypothetical aspirin-prescribing decisions and improved lipid management when the short-term risk was moderately high. High lifetime risk sometimes led to more intensive prescription of aspirin or lipid-lowering medication. This outcome suggests that, to maximize the benefits of risk-calculating tools, specific guideline recommendations should be provided along with risk estimates.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2009.525
UR  - http://dx.doi.org/10.1001/archinternmed.2009.525
ER  -