Evidence map›Paper›PMID 24833688›Full record

Trial reportBMJ open2014

General practitioners' use of absolute risk versus individual risk factors in cardiovascular disease prevention: an experimental study.

Jesse Jansen, Carissa Bonner, Shannon McKinn, Les Irwig, Paul Glasziou, Jenny Doust, Armando Teixeira-Pinto, Andrew Hayen, Robin Turner, Kirsten McCaffery

Abstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Sex-Specific Blood Pressure Thresholds in Middle-Aged Adults.Hypertension (Dallas, Tex. : 1979) · 2026
    Article
  5. Article
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  8. Factors predicting statin prescribing for primary prevention: a historical cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021
    Article
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  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Personalized medicine and stroke prevention: where are we?Vascular health and risk management · 2015
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jesse JansenScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
Carissa BonnerScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
Shannon McKinnScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.
Les IrwigScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Paul GlasziouScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Research in Evidence Based Practice Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
Jenny DoustScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Research in Evidence Based Practice Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
Armando Teixeira-PintoScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Andrew HayenSchool of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Robin TurnerScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Kirsten McCafferyScreening and Test Evaluation Program (STEP), School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo understand general practitioners' (GPs) use of individual risk factors (blood pressure and cholesterol levels) versus absolute risk in cardiovascular disease (CVD) risk management decision-making.

designRandomised experiment. Absolute risk, systolic blood pressure (SBP), cholesterol ratio (total cholesterol/high-density lipoprotein (TC/HDL)) and age were systematically varied in hypothetical cases. High absolute risk was defined as 5-year risk of a cardiovascular event >15%, high blood pressure levels varied between SBP 147 and 179 mm Hg and high cholesterol (TC/HDL ratio) between 6.5 and 7.2 mmol/L.

setting4 GP conferences in Australia.

participants144 Australian GPs. OUTCOMES: GPs indicated whether they would prescribe cholesterol and/or blood pressure lowering medication. Analyses involved logistic regression.

resultsFor patients with high blood pressure: 93% (95% CI 86% to 96%) of high absolute risk patients and 83% (95% CI 76% to 88%) of lower absolute risk patients were prescribed blood pressure medication. Conversely, 30% (95% CI 25% to 36%) of lower blood pressure patients were prescribed blood pressure medication if absolute risk was high and 4% (95% CI 3% to 5%) if lower. 69% of high cholesterol/high absolute risk patients were prescribed cholesterol medication (95% CI 61% to 77%) versus 34% of high cholesterol/lower absolute risk patients (95% CI 28% to 41%). 36% of patients with lower cholesterol (95% CI 30% to 43%) were prescribed cholesterol medication if absolute risk was high versus 10% if lower (95% CI 8% to 13%).

conclusionsGPs' decision-making was more consistent with the management of individual risk factors than an absolute risk approach, especially when prescribing blood pressure medication. The results suggest medical treatment of lower risk patients (5-year risk of CVD event <15%) with mildly elevated blood pressure or cholesterol levels is likely to occur even when an absolute risk assessment is specifically provided. The results indicate a need for improving uptake of absolute risk guidelines and GP understanding of the rationale for using absolute risk.

Indexed as

General PracticePractice Patterns, Physicians'Risk AssessmentBlood PressureCardiovascular DiseasesCholesterolClinical Decision-MakingFemaleHumansMaleMiddle AgedRisk FactorsRisk ManagementCholesterolCardiologyGeneral Medicine (see Internal Medicine)Public Health

Identifiers

PMID24833688
PMCPMC4025465

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.