Abstract 881: Trends in Contemporary Cardiovascular Risk Assessment in Canada: Results of the PARADIGM Perceptions Study
Objective: There are limited data in the contemporary era as to how primary care physicians (PCP) assess global cardiovascular risk and incorporate non-traditional risk factors in their decision making.
Methods: We conducted a prospective cross-sectional survey of 652 Canadian PCP. Using a structured and validated tool, we evaluated their perceptions around risk assessment, treatment thresholds, and novel biomarkers.
Results: PCP indicated that they used the Framingham Risk Score (FRS) to estimate global risk in 67% of cases, yet 31% incorrectly identified a high-risk patient according to the FRS. Non-classical risk factors such as family history or central obesity were identified by 40% as the single most important determinant of initiating formal risk assessment. PCP reported that they reclassified patients into high-risk categories in the presence of metabolic syndrome or positive family history in 62% and 64% of cases respectively. Waist circumference (WC) was considered as a vital sign by 84% yet only 6% reported routinely documenting this. Inflammation was identified as the main mechanism of atherosclerosis by 50% of PCP, and 100% were aware of hsCRP. However, 51% were unclear about the clinical utility of this biomarker to risk stratify an intermediate risk patient beyond traditional risk factors, and 73% were unsure if elevated hsCRP identified a patient population for statin treatment. CT angiography was identified by 24% as the best test for screening in primary prevention.
Conclusions: PCP incorporate non-traditional measures, in addition to FRS, in risk stratification. Although central obesity was identified as one of the single most important factor prompting formal risk assessment, WC was documented by fewer than 6% of PCP. The majority of respondents were unclear about the clinical utility of hsCRP in risk stratification or treatment. One quarter of PCP suggested that CTA was the best suited test for screening large populations.