Researchers Say Doctors Are Missing Opportunities to Prevent Heart Disease

May 12, 2009 - A new study shows that, despite protocols which recommend aggressive screening for risk factors like elevated blood pressure and cholesterol, far too many patients with heart disease are being diagnosed only after they develop symptoms. The study appears in the May issue of The International Journal of Clinical Practice.

A survey of nearly 14,000 people with diabetes or other risk factors for cardiovascular disease indicates that doctors routinely miss opportunities to identify heart problems early. Merely one in five surveyed patients with heart disease said their diagnosis was made as a result of routine screening. More than half of patients with type 2 diabetes, and slightly less than half of patients without diabetes are diagnosed only after they developed symptoms. "The fact that only a small number of people are being diagnosed as a result of screening indicates that we are missing opportunities to prevent heart disease," said epidemiologist and study co-author Kathleen M. Fox, PhD. Fox is president of Strategic Healthcare Solutions, a private health research group.

The study included a nationally representative sample of patients with diabetes or other major risk factors for heart disease. Heart patients diagnosed after the American Heart Association (AHA) and the American College of Cardiology (ACC) revised their screening guidelines were only slightly more likely to be diagnosed during routine screening as patients diagnosed before this time, Fox says.

The AHA and ACC now recommend that:

• All adults should be assessed for cardiovascular disease risk factors beginning at age 20. Family history of heart disease should be regularly updated.
• Doctors should ask patients about their smoking status, diet, alcohol intake, and physical activity level at every routine evaluation.
• Blood pressure, body mass index, waist circumference, and pulse should be recorded at each visit and at least once every two years.
• Fasting serum lipoprotein profile, or total and HDL cholesterol, and fasting blood glucose should be measured as determined by the patient's risk for diabetes and high cholesterol at least every five years and every two years if patients have risk factors.
• All adults 40 or older should know their absolute risk of developing cardiovascular disease. This is especially important for people 40 and older and those with two or more risk factors for heart disease consistent with NCEP guidelines

Former American Heart Association President and current dean of the University of Mississippi School of Medicine Daniel W. Jones, MD says of the study: "It is clear that within our current health care delivery system we are doing a poor job of focusing on disease prevention. As we reform that system, we need to find better ways to apply the prevention strategies that we know work." He likened current disease prevention efforts to the old days of auto maintenance.
"When I was much younger the only place I could get my oil changed was the place that repaired cars," he says. "It was inconvenient for me and a nuisance for the mechanic. Now we have convenient places where all they do is change the oil and do other maintenance. They don't repair cars; they focus on prevention and because of these places people maintain their cars much better than they used to."