Assessment of cardiovascular risk in primary care patients in France

Background. - Current guidelines for the prevention of cardiovascular disease emphasize the importance of assessing global cardiovascular risk, but there is evidence that risk is often assessed inaccurately. Aims. To compare general practitioner-reported global cardiovascular risk in French primary care patients with estimates based on established risk-scoring systems, and to identify factors accounting for any mismatch between the analyses. Methods. - Data on patients aged greater or equal to 50 years seen during two 3-day periods were provided by 619 general practitioners. Physicians rated each patient's cardiovascular risk as tow, moderate or high, according to their perception; in addition, risk was assessed using the Framingham and Systematic coronary risk evaluation (SCORE) risk-scoring systems. Results. - A total of 13,446 patients aged greater or equal to 50 years were included. Of 11,241 patients with no previous history of cardiovascular disease, 47% were considered by their physicians to be at low risk of cardiovascular disease and 14% to be at high risk. In that population, 72% of patients rated as high risk according to the Framingham system and 77% rated as high risk according to SCORE system were incorrectly assessed by their physicians; similar results were observed in patient cohorts based on whether or not patients had received treatment for dyslipidaemia. Weighted kappa analysis showed poor agreement between physician risk assessment and both the Framingham and SCORE risk-scoring systems. Conclusion. - This study underlines the mismatch between GP-estimated cardiovascular risk and the risk assessed using scoring systems, especially for high-risk patients. (C) 2011 Elsevier Masson SAS. All rights reserved.