Randomised evaluation of a specific training of general practitioners in cardiovascular prevention

Abstract

OBJECTIVE: A lack of global cardiovascular (CV) risk approach is often observed in the clinical practice. Having conceived a clinical strategy aimed at helping general practitioners (GPs) to assess and manage global CV risk in the daily practice, we wanted to evaluate the impact of a training promoting this strategy. METHODS: Randomised controlled trial involving GPs registered in a continual medical education (CME) group. The intervention and control arms included 7 (123 GPs) and 13 (220 GPs) groups, respectively. The intervention was a training in CV prevention provided during a CME meeting. GPs answered a questionnaire four months after the training. The main outcome was the use of a global CV risk assessment tool. Secondary outcomes were the GPs' awareness of the CV diseases burden, knowledge of the CV risk factors, and CV therapeutic attitudes. RESULTS: More trained GPs (76% vs. 52%) used a global CV risk assessment tool (p = 0.003). Significant differences were also observed for secondary outcomes: (a) awareness of CV diseases burden: more trained GPs were aware of the lethality from myocardial infarction (37% vs. 21%, p = 0.047) and considered it as the main cause of sudden death in adults (78% vs. 59%, p = 0.018); (b) knowledge of risk factors: more trained GPs considered familial CV history (89% vs. 73%, p = 0.021) and HDL-cholesterol (82% vs. 62%, p = 0.013) as important CV risk factors; (c) therapeutic attitudes: fewer trained GPs used to prescribe a lipid-lowering drug based on a total cholesterol value without considering the other risk factors (44% vs. 65%, p = 0.013). CONCLUSIONS: The global CV risk approach in the general practice was favourably influenced by this training provided during a CME meeting. The impact of the training on patients' outcomes should be addressed in a prospective trial.