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Less than
1 in 5 heart problems are diagnosed before
symptoms appear
Clinicians are missing golden opportunities
to identify heart disease before patients
start displaying symptoms, according to a
study of 13,877 people published in the May
issue of UK-based IJCP, the International
Journal of Clinical Practice.
Researchers from Oregon, Maryland and
Delaware, USA, found that just over 11% of
the respondents had been diagnosed with
heart disease.
However, only 19% of those individuals - who
had been involved in the ongoing study for
two years - said that their heart disease
was picked up during routine screening.
More than half of the diabetic patients with
heart disease who took part in the study
(54%) reported that their heart disease was
diagnosed when they became symptomatic and a
further 22% said it was picked up while they
were being treated for other health issues.
The figures were lower for individuals
without diabetes. Just under half (48%) were
diagnosed with heart disease when they
became symptomatic and 15% were picked up
during treatment for other conditions.
"Our study showed that not enough patients
with heart disease are being picked up
during routine screening or treatment for
conditions like diabetes, which are commonly
associated with heart problems" says lead
author Dr Sandra J Lewis from the Northwest
Cardiovascular Institute in Portland,
Oregon.
"The
majority of those who took part in the study
were not diagnosed until they started
displaying symptoms."
Coronary heart disease (CHD) is the leading
cause of death in the United States,
accounting for more than 450,000 deaths a
year. Approximately 15.8 million Americans
who are 20 or older suffer from the disease.
"Many individuals do not show symptoms and
go undiagnosed until the disease is in an
advanced state, often when they have
actually had a heart attack" explains Dr
Lewis.
"That is why it is so important to diagnose
CHD before patients experience their first
crisis, by looking at major risk factors
such as smoking, having high blood
cholesterol, having high blood pressure,
being overweight, being physically inactive
or just getting older.
"Guidelines recommend that all adults over
the age of 20 should receive risk factor
screening from their family doctor every two
to five years.
There are more specific guidelines for
patients with type 2 diabetes as their risk
of a heart attack is twice as high as the
general population."
The analysis from the SHIELD study (Study to
Help Improve Early evaluation and management
of risk factor Leading to Diabetes) was
performed to see if ongoing recommendations
for improved screening in the USA were
resulting in more patients being diagnosed
with heart disease before they became
symptomatic.
It forms part of the larger SHIELD survey of
211,097 US households who responded to a
national questionnaire.
More than 18,400 people who had participated
in the baseline and first follow-up SHIELD
surveys - and had diabetes or one of the
five cardiometabolic risk factors - were
sent questionnaires and 13,877 (75%)
responded.
Of these, 1,573 (11% of the total) had been
diagnosed with heart disease.
Just under two-thirds had heart disease on
its own (62%). They were predominantly male
(59%) and white (91%) with an average age of
67. The remaining 38% had heart disease and
type 2 diabetes.
They were slightly more likely to be women
(50.7%), 88% were white and their average
age was 69.
The average time since diagnosis was 11.7
years in CHD patients without diabetes and
10.7 years in individuals with diabetes and
CHD.
Almost a third of the non diabetes group
(31%) and 36% of the diabetes group had been
diagnosed since 2001 when a number of
consensus statements and guidelines on
screening and prevention were published.
"Despite increased knowledge and awareness
of the risk factors for CHD, many
individuals are not diagnosed with heart
disease until they are symptomatic"
concludes co-author Dr Kathleen Fox from
Strategic Healthcare Solutions in Monkton,
Maryland.
"The fact that only a small percentage of
the SHIELD respondents were diagnosed
through screening indicates that there is a
missed opportunity to diagnose heart disease
during earlier, less severe stages of the
disease.
"As blood pressure and weight are evaluated
when most patients visit their family
doctor, medical providers already have
information about two key modifiable risk
factors.
"Our study demonstrates the need for
improved targeted education aimed at both
patients and doctors to reduce heart disease
before symptoms occur."
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