Physicians' estimates of the 10 year cardiovascular risk in hypertensive patients: an evaluation in primary care physicians in training.

Objective: To evaluate how young physicians in training perceive their patients’ cardiovascular risk based on the medical charts and their clinical judgment. Design: Cross sectional observational study. Setting: University outpatient clinic, Lausanne, Switzerland. Subjects: Two hundred hypertensive patients and 50 non-hypertensive patients with at least one cardiovascular risk factor. Main outcome measure: Comparison of the absolute 10-year cardiovascular risk calculated by a computer program based on the Framingham score and adapted for physicians by the WHO/ ISH with the perceived risk as assessed clinically by the physicians. Results: Physicians underestimated the 10-year cardiovascular risk of their patients compared to that calculated with the Framingham score. Concordance between methods was 39% for hypertensive patients and 30% for non-hypertensive patients. Underestimation of cardiovascular risks for hypertensive patients was related to the fact they had a stabilized systolic blood pressure under 140 mm Hg (OR = 2.1 [1.1; 4.1]). Conclusions: These data show that young physicians in training often have an incorrect perception of the cardiovascular risk of their patients with a tendency to underestimate the risk. However, the calculated risk could also be slightly overestimated when applying the Framingham Heart Study model to a Swiss population. To implement a systematic evaluation of risk factors in primary care a greater emphasis should be placed on the teaching of cardiovascular risk evaluation and on the implementation of quality improvement programs.