NATIONAL TRENDS IN THE MANAGEMENT OF CARDIOVASCULAR-DISEASE RISK-FACTORS IN CHILDREN - 2ND NHLBI SURVEY OF PRIMARY-CARE PHYSICIANS

Background. The evidence that atherosclerosis begins during adolescenc e has led to the belief that primary prevention of cardiovascular dise ase (CHD) should commence in childhood. Although several national guid elines have been issued for the defection and treatment of CHD risk fa ctors in children, concerns continue to be expressed regarding what co nstitutes appropriate measures and when to institute such measures in children. A 1988 national survey of primary care physicians revealed v ariation in the management of CHD risk factors in children by physicia n categories, which suggested the underlying quandary among physicians regarding CHD risk factors in children. Objective. To assess current clinical management of pediatric CHD risk factors in the primary care setting and also to evaluate time trends between the current and 1988 surveys. Methods. A 25-minute telephone survey was conducted with 1036 of eligible physicians tie, >20 hours per week direct patient care in cluding at least five pediatric patient contacts) selected from a nati onal probability sample in three practice categories (family practitio ners, pediatricians, and general practitioners). The questionnaire ass essed the current practice of these physicians in the primary care set ting regarding cholesterol and blood pressure (BP) screening and treat ment, both nonpharmacologic and pharmacologic, and physician attitude and knowledge. Results. Cholesterol screening in children was performe d by 75.7% of all physicians. Nonscreening was highest among general p ractitioners (38%) and lowest among pediatricians (12%). BP was measur ed by almost all physicians. The majority of physicians (71%) prescrib ed diet as the first cholesterol-lowering step, but similar to 16% als o used pharmacologic therapy. Cholesterol synthesis inhibitors and bil e acid sequestrants were the drugs used most commonly. Approximately 2 5% of physicians have used drugs in children to treat high BP. Diureti cs and beta-blockers were used most frequently. More than one fourth o f the physicians had some concern about identifying and treating child ren for CHD risk factors. There was slightly less cholesterol measurem ent in 1995 compared with 1988, and no notable increase in the knowled ge regarding major CHD risk factors. Conclusion. The results of the se cond National Heart, Lung, and Blood Institute survey of primary care physicians suggest that additional inroads need to be made in the diss emination of the national guidelines for the management of CHD risk fa ctors in children, including appropriate use of pharmacologic agents.