Archief Roodbont

Knowledge gap blamed for undertreatment of vascular patients

3 November 2008

MedWire News: A knowledge gap is leading physicians to underprescribe antiplatelet drugs, ACE inhibitors, and statins to high-risk cardiovascular patients, researchers have found.

Underuse of these therapies has been extensively documented, but the reasons physicians fail to prescribe them are unclear, say the authors in the American Journal of Cardiology.

Using two large national outpatient registries, the researchers analyzed the prescription pattern of evidence-based medicine for 6251 patients with high cardiovascular risk, as defined by criteria adapted from the Heart Outcome Prevention Evaluation Study.

Jennifer Tsang (University of Toronto, Ontario, Canada) and co-workers note that despite ample evidence and guideline recommendations “there was suboptimal use of antiplatelet drugs, ACE inhibitors, and statins (78%, 55%, and 75% respectively).” The researchers say this represents “a significant care gap.”

Physicians participating in the registries were asked to complete case-report forms explaining why they chose not to prescribe these agents. For 5%, 14%, and 33% of patients not receiving antiplatelets, ACE inhibitors, and statins, respectively, prescribing physicians did not think these patients were at high enough risk for subsequent events to justify the use of these agents.

The researchers observed that “simply asking physicians why some of their patients were not on a specific therapy led to an approximate 19% to 36% of these patients subsequently being prescribed such therapies.”

They conclude that two important components of the evidence-to-practice care gap are: “a knowledge gap caused by lack of awareness of the evidence and/or familiarity with current guidelines” and “a practice gap in which some physicians responded to a simple patient-specific prompting to reconsider the use of evidence-based therapies.”

The researchers suggest a range of quality enhancement initiatives to help close treatment gaps, including “the use of achievable benchmarks for physician feedback, local medical opinion leaders, community pharmacist intervention, and computer-based clinical decision support systems.”

Am J Cardiol 2008; 102: 1142–1145