Table 3

Differences in practice patterns of family physicians and general internist respondents in managing CVD* risk

Family Physicians

(N = 562)

General Internists

(N = 326)

p-value


Antiplatelet therapy for prevention of myocardial infarction in a 45-year-old

asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2,

LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose


Aspirin 100 mg every other day

0.9%

0.9%

< 0.01

Aspirin 81 mg daily

65.6%

54.3%

Aspirin 325 mg daily

4.8%

5.8%

Clopidogrel 75 mg daily

0.9%

2.5%

No antiplatelet therapy**

27.8%

36.5%


Dyslipidemia pharmacotherapy recommendation for a 45-year-old

asymptomatic woman with one BP reading of 145/90 mm Hg, BMI 28 kg/m2,

LDL 125 mg/dL, HDL 55 mg/dL, TG 200 mg/dL, and normal glucose


Atorvastatin 10 mg every evening

42.4%

41.0%

0.84

Ezetimide 10 mg daily

2.5%

4.3%

Niacin 500 mg twice daily

3.9%

3.7%

No specific therapy for dyslipidemia**

51.2%

50.9%


Dietary recommendation (avoiding fat) for a 45-year-old asymptomatic woman

with one BP reading of 145/90 mm Hg, BMI 28 kg/m2, LDL 125 mg/dL, HDL 55

mg/dL, TG 200 mg/dL, and normal glucose


Trans fatty acids**

62.5%

61.8%

0.91

Polyunsaturated fats

9.6%

9.2%

Mono-unsaturated fats

3.2%

5.8%

No specific fat as long as it

does not exceed 30% of

total intake

24.6%

23.1%


LDL Goal for a 50-year-old asymptomatic man, negative family history of

premature CHD, BP 170/94 mm Hg, BMI 26 kg/m2, total cholesterol 210 mg/dL,

LDL 130 mg/dL, HDL 36 mg/dL, TG 256 mg/dl, Fasting glucose 140 mg/dL, and

normal exercise stress test


LDL < 130 mg/dl

11.8%

12.3%

0.36

LDL < 100 mg/dl**

59.0%

56.0%

LDL < 70 mg/dl

29.2%

31.7%


Hypertension and dyslipidemia management for a new asymptomatic 78-year-

old female patient with questionable history of diabetes, BP 159/78 mm Hg, BMI

29 kg/m2, LDL 199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0%


Lifestyle and dietary

modification

6.8%

8.0%

0.11

Lifestyle and dietary

modification and treatment with

a thiazide diuretic

6.6%

5.2%

Lifestyle modification and

treatment with a statin

14.9%

10.2%

Lifestyle and dietary

modification and treatment with

both a thiazide diuretic and a

statin**

71.7%

76.5%


Approach to stress testing for a new asymptomatic 78-year-old female patient

with questionable history of diabetes, BP 159/78 mm Hg, BMI 29 kg/m2, LDL

199 mg/dL, TG 479 mg/dL, and HbA1c of 6.0%


I would order one as a

follow up to today's visit

39.6%

33.0%

0.88

I would order one today

and yearly thereafter

5.6%

10.5%

I would order a test if she

develops symptoms of chest

pain, shortness of breath or

atypical angina**

48.1%

48.8%

I would not order a stress test

on this elderly woman

6.7%

7.7%


*CVD, cardiovascular disease, CHD, coronary heart disease

**Evidence-based guideline choice. T-test was performed comparing the two groups and their responses to the evidence-based guideline choice.

Doroodchi et al. BMC Family Practice 2008 9:42   doi:10.1186/1471-2296-9-42

Open Data