Audit of cardiovascular risk assessment and lipid management by Canadian primary care physicians
Bibliographic record
Abstract
bACKGRouNd: Assessment of cardiovascular risk is an essential component of preventive cardiology.Despite guideline recommendations, risk assessment remains highly variable.Further efforts to understand the knowledge and action gaps for risk assessment and lipid management in contemporary primary care are warranted.MeThodS: A retrospective chart audit of 105 physicians participating in an observational registry of healthy middle-age Canadians free of known cardiovascular disease (CVD), diabetes or treated dyslipidemia seen between 2008 and 2009 was conducted.ReSulTS: A total of 1061 patients from across Canada were reviewed.The mean age was 57 years, 61% were male, 75% were Caucasian, 39% were hypertensive and 29% had a smoking history.The Framingham risk score (FRS) was used by 61% of physicians for CVD risk assessment.Overall, 48% of patients were considered to be low risk, 40% intermediate and 12% high risk by physician assessment.This was a significant overestimation of risk (P<0.0001)compared with centrally derived FRS of 64%, 26% and 10%, respectively.Risk was overestimated more often in women (P<0.002).Statin therapy was prescribed to 390 patients (37%); however, 36.5% of patients who were eligible for treatment, according to national guidelines, were not treated, while 19.9% of noneligible patients did receive therapy.CoNCluSioNS: Despite guideline recommendations, the FRS was underutilized by Canadian primary care physicians.There was considerable discrepancy between centrally derived and physician-derived risk scores.Appropriate statin therapy appeared to be underprescribed by physicians despite an overestimation of risk.Improved dissemination of risk stratification tools and guideline recommendations are needed to optimize CVD risk reduction in primary care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".