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Primary Prevention of Cardiovascular Diseases in General Practice: Mismatch between Cardiovascular Risk and Patients' Risk Perceptions
T. van der Weijden, PhD, MD
Department of General Practice/Centre for Quality of Care Research (WOK), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands, Trudy.vanderWeijden{at}hag.unimaas.nl
B. van Steenkiste
Department of General Practice/Centre for Quality of Care Research (WOK), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
H.E.J.H. Stoffers, PhD, MD
Department of General Practice/Centre for Quality of Care Research (WOK), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
D.R.M. Timmermans, PhD
Department of Social Medicine, VU University Medical Centre, Amsterdam, The Netherlands
R. Grol, PhD
Department of General Practice/Centre for Quality of Care Research (WOK), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
Objective. Guidelines on primary prevention of cardiovascular disease (CVD) emphasize identifying high-risk patients for more intensive management, but patients' misconceptions of risk hamper implementation. Insight is needed into the type of patients that general practitioners (GPs) encounter in their cardiovascular prevention activities. How appropriate are the risk perceptions and worries of patients with whom GPs discuss CVD risks? What determines inappropriate risk perception? Method. Cross-sectional study in 34 general practices. The study included patients aged 40 to 70 years with whom CVD risk was discussed during consultation. After the consultation, the GPs completed a registration form, and patients completed a questionnaire. Correlations between patients' actual CVD risk and risk perceptions were analyzed. Results. In total, 490 patients were included. In 17% of the consultations, patients were actually at high risk. Risk was perceived inappropriately by nearly 4 in 5 high-risk patients (incorrect optimism) and by 1 in 5 low-risk patients (incorrect pessimism). Smoking, hypertension, and obesity were determinants of perceiving CVD risk as high, whereas surprisingly, diabetic patients did not report any anxiety about their CVD risk. Men were more likely to perceive their CVD risk inappropriately than women. Conclusion. In communicating CVD risk, GPs must be aware that they mostly encounter low-risk patients and that the perceived risk and worry do not necessarily correspond with the actual risk. Incorrect perceptions of CVD risk among men and patients with diabetes were striking.
Key Words: primary prevention • cardiovascular diseases • risk tables • risk score sheet • risk communication • risk perception.
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This version was published on December
1, 2007
Medical Decision Making, Vol. 27, No. 6,
754-761 (2007)
DOI: 10.1177/0272989X07305323
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