Younger Doctors Treat Cardiovascular Disease Better

May 24, 2011

May 23, 2011 (Rome, Italy) — Younger doctors appear to be diagnosing and treating cardiovascular disease better than their older colleagues, according to the results of an Italian study [1].

The study, published in the June 2011 issue of the International Journal of Clinical Practice, was conducted by a team led by Dr Giuliano Tocci (Sant'Andrea Hospital, Rome, Italy).

Tocci commented to heartwire : "We found that younger doctors followed best practice more than older doctors. Younger doctors were more likely to order diagnostic tests for global cardiovascular risk stratification as advised by guidelines and prescribed more guideline-recommended drugs, such as antiplatelet and glucose- and lipid-lowering agents, whereas older doctors were more likely to recommend lifestyle changes. And patients treated by older doctors had a lower rate of control of major cardiovascular risk factors, such as hypertension, dyslipidemia, and diabetes."

He said these results reflected the better education of younger doctors. "In the past two decades there have been a growing number of specialist physicians, who have better education that reflects the most modern guidelines."

Too Many Guidelines

While Tocci says the availability of treatment guidelines are very useful, he thinks there are too many different sets of guidelines, which can be confusing for doctors. "We have several different guidelines for renal disease, blood pressure, cholesterol, diabetes, etc. Older doctors find it difficult to keep up with them all. We need fewer, simpler, more integrated guidelines."

The study also found that use of electronic support by doctors improved global cardiovascular risk management. Tocci gave the example of recording a high blood pressure result electronically, leading to a prompt that treatment was necessary. And unsurprisingly, young doctors were more likely to use electronic devices to improve practice than older doctors. Tocci suggested that additional educational support should be directed toward older doctors, especially in the use of electronic practice aids.

The study found that younger doctors in the survey were more likely to be specialists, whereas older doctors were more likely to be general practitioners. While this accounted for some of the trend seen toward better practice in younger doctors, Tocci said the results remained the same after controlling for this variable.

The study did, however, find that aging in physicians was associated with improved accuracy in recording patients’ clinical data, with older physicians tending to provide significantly more clinical data.

Tocci said the most unsatisfactory result in the study was the level of control of hypertension, which was poor, irrespective of the age of referring physicians. "Although 75% of the patient population was hypertensive, only 40% had their blood pressure controlled adequately. Everyone needs better education. This confirms the undertreatment of hypertension as a key element for the global burden of CV diseases in Western countries, including Italy," he said.

In the study, 1078 general practitioners, cardiologists, and diabetologists in Italy were asked to provide data on their 10 most recent patients' cardiovascular or metabolic disease, including figures on blood-pressure control, cholesterol, body-mass index, age, weight, diagnostic tests ordered, and medications prescribed. Data on a total of 9904 patients were analyzed. Physicians involved were stratified into three age groups--below 45 years, 46 to 55 years, and over 55 years.


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