Early Detection of Cardiovascular Disease Risk Does Little to Patient Behavior
Madison, Wisconsin - A screening test that predicts your risk of developing cardiovascular disease (CVD) is more likely to change your physician's behavior than your own.
Researchers at the University of Wisconsin-Madison found that physicians who conducted in-office carotid ultrasound screenings (CUS) significantly modified their treatment approach for patients with abnormal test results, but the patients themselves did little to change behaviors that could improve their long-term health.
"Primary-care providers who used these screenings were more likely to employ preventive strategies earlier for some patients, many of whom would not have previously qualified for cholesterol-lowering medication or aspirin," said Dr. James Stein, director of Preventive Cardiology at the University of Wisconsin Hospital and Clinics and professor of medicine at the UW-Madison School of Medicine and Public Health. "Unfortunately, the screenings had only a modest impact, at best, on helping patients exercise more, eat healthier and lose weight."
The study, which is the first of its kind to examine the effects of CUS findings on physician decision-making and patient health-related behaviors, appears in the July issue of the Journal of the American Society of Echocardiography.
The following are some of the study's most important results regarding physician and patient behavior.
If an abnormal CUS was detected:
- Patients were more likely to believe they would increase exercise goals, make dietary changes and quit smoking, but the only self-reported change after 30 days was a modest increase in dietary fiber intake and a decrease in salt consumption.
- Physicians nearly doubled the number of patients who received either an increase in or a first-time prescription for lipid-lowering medications or aspirin therapy, from 113 patients (47.4 percent) to all 238 patients (100 percent).
- Physicians lowered LDL cholesterol targets from 130 to 100 mg/dL or from 100 to 70 mg/dL.
Although the study showed that patients who underwent CUS did express a greater awareness of their cardiovascular disease risks and an increase in their perceived ability to change certain behaviors, a substantial number of those patients reported making no significant lifestyle changes, other than minor dietary adjustments. Dr. Stein says those results underscore the limitations of one-time interventions and support the need for recurring CVD risk education and counseling for patients.
Carotid ultrasound screening measures plaque buildup and thickness in the carotid artery of the neck, which can help assess a patient's risk for having a heart attack or a stroke. Physicians can use this information to provide more precise estimates of risk to their patients or to start preventive care earlier.
Dr. Stein helped pioneer the CUS technique and lead the committee that made formal recommendations on how to use the test in clinical settings. Now widely used throughout the U.S., CUS is considered a safe and low-cost method for identifying diseased arteries in patients before symptoms appear.
Five non-academic, community practices in southern and central Wisconsin and 355 patients aged 40 to 70 participated in the study. Physicians completed questionnaires before and immediately following the CUS to determine changes in their treatment and management approach. Patients completed pre- and post-screening surveys to measure their understanding of their risk as well as their motivation and intention to change some health-related behaviors. Patients received an additional survey 30 days later to measure how well they were doing with those behavioral changes.
"It's likely that the very act of screening itself, not the results of the test, may have motivated some patients to exercise more, eat healthier and control their weight, but I am more impressed by the effects of screening on the behavior of health care providers," Stein said.
The research was funded by a grant from the Medical Education and Research Council Collaborative Health Sciences Program of the Wisconsin Partnership Fund.
Date Published: 07/15/2011