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Differences in Generalists' and Cardiologists' Perceptions of Cardiovascular Risk and the Outcomes of Preventive Therapy in Cardiovascular Disease

Peter D. Friedmann, MD, MPH; Allan S. Brett, MD; and Michael F. Mayo-Smith, MD, MPH
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From Deaconess Hospital and Harvard Medical School, Boston, Massachusetts; and Veterans Affairs Medical Center, Manchester, New Hampshire. Acknowledgments: The authors thank Mark S. Roberts, MD, MPP, and Richard Saitz, MD, MPH, for help with the study design; Theodore G. Karrison, PhD, and Hiroaki Minato for statistical assistance; and Christine K. Cassel, MD, Marshall H. Chin, MD, MPH, Nicholas A. Christakis, MD, PhD, MPH, and Greg A. Sachs, MD, for their helpful comments. Requests for Reprints: Peter D. Friedmann, MD, MPH, Section of General Internal Medicine, University of Chicago, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637. Current Author Addresses: Dr. Friedmann: Section of General Internal Medicine, University of Chicago, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(4):414-421. doi:10.7326/0003-4819-124-4-199602150-00005
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Objective: To compare generalists' and cardiologists' estimates of baseline cardiovascular risk and the outcomes of preventive therapy.

Design: Cross-sectional mail survey using written case simulations of typical patients from primary prevention trials for hypercholesterolemia and isolated systolic hypertension, and tertiary prevention studies of coronary artery bypass surgery for chronic stable angina with left main coronary stenosis.

Participants: Nationally representative sample of 599 practicing family physicians, general internists, and cardiologists selected from the American Medical Association masterfile. Among eligible physicians, 84 (44%) of 191 family physicians, 77 (40%) of 194 general internists, and 66 (34%) of 194 cardiologists responded.

Measurements: Estimates of risk at baseline and after therapy, and whether therapy generally would be recommended.

Results: For both primary prevention case simulations (scenarios), cardiologists provided lower, more accurate estimates of baseline cardiovascular risk and of absolute therapeutic benefit than either family physicians or general internists. The range of the generalists' estimates was extremely wide. Perceptions of relative risk reduction and treatment recommendations for the primary prevention scenarios did not differ among specialties. Overall, generalists who would not recommend primary preventive therapy in these scenarios appeared to give more accurate estimates than did generalists who would recommend such therapy.

Conclusions: Many generalists have inflated perceptions of cardiovascular risk without treatment and of the benefit of risk-modifying medical treatment. Further study should assess the reasons for these misperceptions and their effect on counseling about primary preventive therapy.





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