Patient and Other Factors Influencing the Prescribing of Cardiovascular Prevention Therapy in the General Practice Setting With and Without Nurse Assessment

Abstract

Background. Although guidelines indicate when patients are eligible for antihypertensives and statins, little is known about whether general practitioners (GPs) follow this guidance. Objective. To determine the factors influencing GPs decisions to prescribe cardiovascular prevention drugs. Design of Study. Secondary analysis of data collected on patients whose cardiovascular risk factors were measured as part of a controlled study comparing nurse-led risk assessment (four practices) with GP-led risk assessment (two practices). Setting. Six general practices in the West Midlands, England. Patients. Five hundred patients: 297 assessed by the project nurse, 203 assessed by their GP. Measurements. Cardiovascular risk factor data and whether statins or antihypertensives were prescribed. Multivariable logistic regression models investigated the relationship between prescription of preventive treatments and cardiovascular risk factors. Results. Among patients assessed by their GP, statin prescribing was significantly associated only with a total cholesterol concentration ≥7 mmol/L and antihypertensive prescribing only with blood pressure ≥160/100 mm Hg. Patients prescribed an antihypertensive by their GP were five times more likely to be prescribed a statin. Among patients assessed by the project nurse, statin prescribing was significantly associated with age, sex, and all major cardiovascular risk factors. Antihypertensive prescribing was associated with blood pressures ≥140/90 mm Hg and with 10-year cardiovascular risk. Limitations. Generalizability is limited, as this is a small analysis in the context of a specific cardiovascular prevention program. Conclusions. GP prescribing of preventive treatments appears to be largely determined by elevation of a single risk factor. When patients were assessed by the project nurse, prescribing was much more consistent with established guidelines.