DO DOCTORS ACCURATELY ASSESS CORONARY RISK IN THEIR PATIENTS - PRELIMINARY-RESULTS OF THE CORONARY HEALTH ASSESSMENT STUDY

Objective-To evaluate the ability of doctors in primary care to assess risk patients) risk of coronary heart disease. Design-Questionnaire s urvey. Setting-Continuing medical education meetings, Ontario and Queb ec, Canada. Subjects-Community based doctors who agreed to enrol in th e coronary health assessment study. Main outcome measure-Ratings of co ronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the ''average'' 40 year old Canadian man and 70 year old Canadian woman. Results-253 doctors answered the questionnaire. For 30 year olds the doctors rated cigaret te smoking as the most important risk factor and raised serum triglyce ride concentrations as the least important; for 70 year old patients t hey rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each in dividual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P < 0.001). They showed a str ong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. W hile doctors accurately estimated the relative risk of a specific pati ent (compared with the average adult) they systematically overestimate d the absolute baseline risk of developing coronary disease and the ri sk reductions associated with specific interventions. Conclusions-Desp ite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctor s. Additional strategies must be developed to help doctors to assess b etter their patients' coronary risk.