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Open Access Highly Accessed Research article

Barriers to apply cardiovascular prediction rules in primary care: a postal survey

Klaus Eichler1*, Marco Zoller2, Peter Tschudi3 and Johann Steurer1

Author Affiliations

1 Horten Centre for patient oriented research, University hospital of Zurich, CH-8091 Zurich, Switzerland

2 Zürcher Ärztegemeinschaft zmed, Grütlistrasse 36, CH-8002 Zurich, Switzerland

3 Institut für Hausarztmedizin, University of Basle, Bläsiring 160, CH-4057 Basle, Switzerland

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BMC Family Practice 2007, 8:1  doi:10.1186/1471-2296-8-1

Published: 3 January 2007



Although cardiovascular prediction rules are recommended by guidelines to evaluate global cardiovascular risk for primary prevention, they are rarely used in primary care. Little is known about barriers for application. The objective of this study was to evaluate barriers impeding the application of cardiovascular prediction rules in primary prevention.


We performed a postal survey among general physicians in two Swiss Cantons by a purpose designed questionnaire.


356 of 772 dispatched questionnaires were returned (response rate 49.3%). About three quarters (74%) of general physicians rarely or never use cardiovascular prediction rules. Most often stated barriers to apply prediction rules among rarely- or never-users are doubts concerning over-simplification of risk assessment using these instruments (58%) and potential risk of (medical) over-treatment (54%). 57% report that the numerical information resulting from prediction rules is often not helpful for decision-making in practice.


If regular application of cardiovascular prediction rules in primary care is in demand additional interventions are needed to increase acceptance of these tools for patient management among general physicians.