Knowledge and implementation of cardiovascular risk clinical practice guidelines by general practitioners and specialists

Introduction and objectives. Patients at a high risk of cardiovascular disease rarely achieve the preventive targets stipulated by the clinical practice guidelines published by professional bodies. The aims of the ACORISC registry were to determine the level of compliance with guidelines on prevention by general practitioners and specialists and to assess the findings in terms of risk factors. Methods. The study included 5849 consecutive patients (mean age 65 years) with type 2 diabetes or chronic ischemic heart disease who were seen as outpatients. In addition, 384 participating physicians were questioned on their knowledge and use of practice guidelines. Results. Overall, 91% of patients also had hypertension. Physicians tended to have better knowledge of and to implement guidelines published by the closest related professional bodies. Some 14% of treatment provided was inappropriate, half of which involved oral antidiabetics. Conversely, 48% of patients for whom guidelines recommended an angiotensin inhibitor did not receive one. The target figures for blood pressure, body mass index, and cholesterol were achieved in only 13%, 21% and 39% of patients, respectively. Conclusions. Overall, 75% of risk factors in patients with diabetes or chronic ischemic heart disease were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines. The inappropriate use of oral antidiabetics was particularly common.