ArticleBMJ (Clinical research ed.)2002
Comparison of estimates and calculations of risk of coronary heart disease by doctors and nurses using different calculation tools in general practice: cross sectional study.
Article in BMJ (Clinical research ed.), 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians.Journal of general internal medicine · 2003Pooled it
- Improving attendance for cardiovascular risk assessment in Australian general practice: an RCT of a monetary incentive for patients.BMC family practice · 2012Trial
- Cardiovascular risk profile and risk stratification of the hypertensive population attended by general practitioners and specialists in Spain. The CONTROLRISK study.Journal of human hypertension · 2007Trial
- Beta-cell age calculator, a translational yardstick to communicate diabetes risk with patients: tehran lipid and glucose study.ISRN family medicine · 2013Article
- Diagnostic classification in patients with suspected deep venous thrombosis: physicians' judgement or a decision rule?The British journal of general practice : the journal of the Royal College of General Practitioners · 2010Article
- Views on primary prevention of cardiovascular disease--an interview study with Swedish GPs.BMC family practice · 2010Article
- Absolute risk representation in cardiovascular disease prevention: comprehension and preferences of health care consumers and general practitioners involved in a focus group study.BMC public health · 2010Article
- Perceptions of risk: understanding cardiovascular disease.Risk management and healthcare policy · 2010Article
- Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE).BMJ (Clinical research ed.) · 2006Article
- Implementation of a pharmacist-led clinic for hypertensive patients in primary care--a pilot study.Pharmacy world & science : PWS · 2005Article
- Physicians' ability to predict the risk of coronary heart disease.BMC health services research · 2003Article
- Primary prevention of coronary heart disease.BMJ (Clinical research ed.) · 2002Article
- New score is needed to predict risk of coronary heart disease.BMJ (Clinical research ed.) · 2002Article
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7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effect of using different risk calculation tools on how general practitioners and practice nurses evaluate the risk of coronary heart disease with clinical data routinely available in patients' records.
designSubjective estimates of the risk of coronary heart disease and results of four different methods of calculation of risk were compared with each other and a reference standard that had been calculated with the Framingham equation; calculations were based on a sample of patients' records, randomly selected from groups at risk of coronary heart disease.
settingGeneral practices in central England.
participants18 general practitioners and 18 practice nurses.
main outcome measuresAgreement of results of risk estimation and risk calculation with reference calculation; agreement of general practitioners with practice nurses; sensitivity and specificity of the different methods of risk calculation to detect patients at high or low risk of coronary heart disease.
resultsOnly a minority of patients' records contained all of the risk factors required for the formal calculation of the risk of coronary heart disease (concentrations of high density lipoprotein (HDL) cholesterol were present in only 21%). Agreement of risk calculations with the reference standard was moderate (kappa=0.33-0.65 for practice nurses and 0.33 to 0.65 for general practitioners, depending on calculation tool), showing a trend for underestimation of risk. Moderate agreement was seen between the risks calculated by general practitioners and practice nurses for the same patients (kappa=0.47 to 0.58). The British charts gave the most sensitive results for risk of coronary heart disease (practice nurses 79%, general practitioners 80%), and it also gave the most specific results for practice nurses (100%), whereas the Sheffield table was the most specific method for general practitioners (89%).
conclusionsRoutine calculation of the risk of coronary heart disease in primary care is hampered by poor availability of data on risk factors. General practitioners and practice nurses are able to evaluate the risk of coronary heart disease with only moderate accuracy. Data about risk factors need to be collected systematically, to allow the use of the most appropriate calculation tools.
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