Survey: Heart Disease Is Underdiagnosed

Researchers Say Doctors Are Missing Opportunities to Prevent Heart Disease

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

May 12, 2009 -- Despite guidelines recommending aggressive screening for risk factors like high blood pressure and cholesterol, far too many patients with heart disease are being diagnosed only after they develop symptoms, a new study shows.

A survey of almost 14,000 people with diabetes or other risk factors for heart disease suggests that doctors are routinely missing opportunities to identify heart problems early, researchers say.

Just one in five surveyed patients with heart disease said they were diagnosed as a result of routine screening.

More than half of patients with type 2 diabetes (55%), and slightly less than half of patients without diabetes (48%) reported having their disease diagnosed after they developed symptoms.

"The fact that only a small number of people reported being diagnosed as a result of screening indicates that we are missing opportunities to prevent heart disease," epidemiologist and study co-author Kathleen M. Fox, PhD, tells WebMD.

Fox is president of Strategic Healthcare Solutions, a private health research group. The study was funded by drugmaker AstraZeneca, which makes the cholesterol-lowering drug Crestor.

Heart Disease: Know Your Risk

Fox says the analysis was conducted in an effort to assess whether strengthened screening guidelines are leading to an earlier diagnosis of heart disease.

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 study appears in the May issue of The International Journal of Clinical Practice.

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. This should be done 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. A widely used and simple 10-year risk model can be found on the National Institutes of Health National Cholesterol Education Program web site.

Health Reform

Former American Heart Association President Daniel W. Jones, MD, tells WebMD that the survey responses should come as no surprise to anyone who has been following the debate about health care reform.

Jones is the dean of the University of Mississippi Medical Center School of Medicine.

"It is clear that within our current health care delivery system we are doing a poor job of focusing on disease prevention," he says. "As we reform that system, we need to find better ways to apply the prevention strategies that we know work."

Because so many people go to doctors only when they get sick, screening is often ignored or conducted as an afterthought, he says.

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."

SOURCES: Lewis, S.J. International Journal of Clinical Practice, May 2009; vol 63: pp 726-734. Kathleen M. Fox, PhD, epidemiologist and president, Strategic Healthcare Solutions, Monkton, Md. Daniel Jones, MD, past president, American Heart Association; dean, University of Mississippi School of Medicine. American Heart Association and the American College of Cardiology: "Guide to Primary Prevention of Cardiovascular Disease and Stroke: Risk Assessment.

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