Survey on the concept and practice of antiplatelet therapy to prevent cardiovascular diseases among community general practitioners in 11 cities of China / 中华全科医师杂志

ABSTRACT

Objective:To assess the concept and clinical practice of general practitioners in community health service centers (CHCs) on the use of antiplatelet drugs (APD) to prevent cardiovascular diseases(CVD).Methods:Based on the eastern, western, southern and northern regions of the country, 350 CHCs were selected from 11 cities across the country with stratified sampling method for study sites, and one general practitioner was selected from each CHC. The questionnaire survey was conducted from March 12 to April 20, 2018 among 350 participants. The content of the questionnaire included the situation of CVD patients, application of APD in primary/secondary prevention of CVD (schemes and regimes), the prescription concept of APD, and influencing factors.Results:Total 350 valid questionnaires were recovered. The survey showed that among all patients general practitioners routinely took care, 46% (30%, 60%) were hypertensive patients; 96.6% (338/350) of the general practitioners said that they had carried out primary prevention, mainly for patients with hypertension, diabetes, dyslipidemia or carotid artery plaque, and 34% (20%, 45%) of the patients had taken primary prevention drugs; the use of APD only accounted for 47% (35%, 60%) , among which 87% (80%, 95%) was aspirin. The main impediments were lack of awareness of disease from patients[ (8.0±1.4) points] and lack of awareness of primary prophylaxis from general practitioners[ (7.3±1.4) points]. The survey also showed that 28% (20%, 35%) and 17% (10%, 20%) patients were diagnosed as coronary heart disease and stroke, respectively; 83% (80%, 95%) of patients with coronary heart disease or stroke used APD for secondary prophylaxis; for coronary heart disease patients, 82% (70%, 95%) taking aspirin or clopidogrel, 18% (5%, 30%) taking aspirin and clopidogrel for 11 months; for stroke patients, 85% (80%, 95%) taking aspirin or clopidogrel, 15% (5%, 20%) taking aspirin and clopidogrel for 9 months. Compared with clopidogrel, aspirin had a relatively high score for clinical experience (8.3±1.1) and reasonable cost of treatment (8.3±1.3) .Most coronary heart disease patients (68%±15%) and stroke patients (70%±17%) took APD regularly. The lack of knowledge of disease [(8.4±1.1) points] and awareness of regular medication [(8.2±1.2) points] were the main factors affecting compliance of patients.Conclusion:The use of APD in primary prevention of CVD for general practitioners is insufficient, and there is still a big gap between the standardization and the practice in secondary prevention; in particular, the selection of APDs and treatment course should strictly follow the guidelines.