Abstract

There is a disconnect between people's perception of their level of risk for cardiovascular disease (CVD), their level of anxiety about getting CVD, and their actual level of risk. These differences in people's perceived and actual risk may lead physicians to focus their prevention efforts on people who are not in the most need or leave patients with unnecessary anxiety. General practitioners must go beyond patients' requests for CVD prevention to ensure patients are receiving appropriate preventative care. Background: Guidelines for the primary prevention of cardiovascular disease (CVD) emphasize identifying high-risk patients for more intensive management. There is, however, a disconnect between people's perception of their level of risk for CVD, their level of anxiety about getting CVD, and their actual risk. These differences between people's perceived level of risk and their actual risk may lead physicians to focus their efforts on people who request CVD prevention counseling, but who are not in the most need of it. Patients may also have anxiety about getting CVD which is not warranted based on their risk factors.

Methods: This study enrolled 490 patients from 34 general practices in Holland. Patients were between the ages of 40 to 70, all of whom had discussed CVD primary prevention with their physician. Following their visit, patients were asked a series of questions to determine whether they see themselves as being either at low risk or high risk for CVD and to determine their level of anxiety about getting CVD. Their general practitioners (GP) also filled in a registration form which provided information on the patient's actual risk factors for CVD.

Findings: People's perception of developing and anxiety about cardio-vascular disease is not affected by whether they are at high or low risk for the disease. Of the 490 patients who participated in the study, all of whom had received a CVD prevention consultation, only 17% were actually high risk. Risk was perceived inappropriately by nearly 4 in 5 high-risk patients (i.e., patients did not recognize their high level of risk) and by 1 in 5 low-risk patients (i.e., patient identified themselves as high risk when they were not). Patients correctly identified smoking, hypertension, and obesity as risk factors for CVD. Patients with diabetes, who are all considered at high risk for CVD, did not recognize their condition as a risk factor. Men were more likely than women to perceive their CVD risk inappropriately.

Conclusions: To ensure high risks patients are receiving appropriate preventative care, general practitioners need to go beyond waiting for patient requests for CVD prevention education There needs to be better communication with patients about who is, and who is not, at high risk of CVD disease. This communication may be a way of lowering anxiety for patients who are anxious about getting CVD, but are actually at low risk for the disease. This in turn may have an impact on health care utilization as resources are more appropriately used for those who are really in need.

Reference: van der Weijden T, van Steenkiste B, Stoffers H, Timmermans D, Grol R. Primary prevention of cardiovascular diseases in general practice: Mismatch between cardiovascular risk and patients' risk perceptions. Medical Decision Making. 2007; 27(6): 754-761.