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Prevention

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Physicians vary widely in providing heart disease prevention services to their patients

Cardiovascular disease (CVD) is the leading cause of death in the United States, accounting for 41 percent of all deaths. Physicians can play an important role in preventing CVD by screening, counseling, and/or suggesting medication to address the risk factors of smoking, hyperlipidemia, hypertension, obesity, and sedentary lifestyle. Yet, depending on their specialty, doctors vary dramatically in their provision of CVD prevention services, with cardiologists being the group most likely to offer them, concludes a study supported in part by the Agency for Health Care Policy and Research (HS07892 and HS09538).

Massachusetts General Hospital researchers Randall S. Stafford, M.D., Ph.D., and David Blumenthal, M.D., M.P.P., analyzed nearly 31,000 adult visits to a national random sample of 1,521 physicians and used mathematical models to estimate the independent effects of physician and patient characteristics on CVD prevention practices. CVD prevention services offered during these visits included blood pressure measurement (50 percent of visits); cholesterol testing (5 percent); counseling for exercise (12 percent), weight (6 percent), cholesterol (4 percent), and smoking (3 percent); and treatment with antihypertensives (12 percent) and lipid-lowering medications (2 percent).

Compared with general internists, cardiologists were more apt to provide CVD prevention services (odds ratio, OR, of 1.65; 1 is equal odds), while obstetricians/gynecologists were less likely to provide these services (OR, 0.68 to 0.82), as were family physicians (OR, 0.64 to 0.74), general practitioners (0.53 to 0.63), other medical specialists (OR, 0.59 to 0.72), and surgeons (0.05 to 0.06). The researchers conclude that primary care physicians vary widely in their practices with regard to CVD prevention and call for efforts to address these practice variations.

See "Specialty differences in cardiovascular disease prevention practices," by Drs. Stafford and Blumenthal, in the Journal of the American College of Cardiology 32, pp. 1238-1243, 1998.


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