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GPs Ignore Heart-Risk Guidelines - Study

Posted on: Sunday, 26 February 2006, 15:00 CST

By HAYMAN, Kamala

GPs are failing to follow national guidelines to identify patients at risk of a heart attack or stroke, according to a Canterbury study.

An ad hoc approach to data collection, revealed in the study, meant lifestyle advice or medical interventions aimed at reducing a patient's risk of a heart attack or stroke were not routinely offered.

This flew in the face of the Health Ministry-funded New Zealand Guidelines Group which said all men over 45 and women over 55 -- 10 years younger for Maori and those with existing risk factors -- should have their heart health assessed.

This involved measuring cholesterol levels, blood-sugar levels, blood pressure and recording age, sex, ethnicity, smoking history, family history, waist circumference, and body mass index.

A patient's individual risk of having a heart attack or stroke within the next five years could then be calculated and preventive action taken where necessary.

But summer studentship studies, part- funded by the National Heart Foundation, of three Rangiora general practices found heart- risk information was not routinely recorded.

Supervisor and Christchurch School of Medicine lecturer Ian Sheerin said the research found GPs were better at collecting information on traditional indicators such as blood pressure and cholesterol levels than at keeping records of body mass index, an indicator of obesity, or physical activity levels.

Sheerin was seeking funding for a pilot screening and treatment programme for cardiovascular risk.

He said there was strong evidence that if at-risk people were given the right treatments their cardiovascular disease risk reduced markedly.

National Heart Foundation medical director Norman Sharpe was not surprised by the research findings. "It would be commonplace in many practices in most areas," he said.

"We're simply not applying (the guidelines) and we're not finding those people at risk."

Sharpe said patient registers should be set up and the staff and resources made available to run a systematic screening programme.

"We do this for our motor cars, why shouldn't we do it for ourselves?"

Offering advice and medication for high-risk patients could see "a great improvement" within two to five years.

"We could make a big difference. But we need to plan for it, find the resources, and do it systematically."

Pegasus Health clinical leader Graham McGeoch said the evidence was clear that screening people for cardiovascular risk and managing their condition would reduce heart disease considerably.

"But it is an expensive strategy."

An Auckland study found just 9 per cent of patients in the eligible age groups had their cardiovascular risk calculated and recorded in their notes.

McGeoch said there remained "a lot of tension" between those seeking funding for health prevention and those seeking money for hospital care. However, he hoped cardiovascular screening would happen within a few years. "We know how to do it, the tools are available ... we probably just need some reorientation of funding to make this happen."

College of GPs president Jonathan Fox said cardiovascular risk assessment was a recognised priority and technology was making screening easier and quicker.

However, time also had to be found to manage patients found to be at high risk. "You need to talk about diet and exercise not just write a 'script and say go and take this. It's time and resource intensive."

Source: Press, The; Christchurch, New Zealand

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