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37. Filippi A, Gensini G, Bignamini AA, Sabatini A, Mazzaglia G, Cricelli C. Management
of patients with suspected angina, but without known myocardial infarction: a
cross-sectional survey
. Br J Gen Pract. 2004;54:429-33.
ABSTRACT. BACKGROUND: Although several studies describing the diagnostic and the-
rapeutic management of patients with myocardial infarction (MI) by general practitioners
have recently been published, little information exists about patients with angina without
MI. AIM: To describe the management of patients with angina without known MI in general
practice. DESIGN: A cross-sectional survey. SETTING: Italian general practitioners providing
data to the Health Search Database. METHOD: Prevalent cases of angina, using the prescrip-
tion of nitrates as a `proxy' for disease status, in patients without known MI were selected
from the Health Search Database. Data on patient demographics, clinical information, esta-
blished therapies and cardiology visits were collected. A binomial logistic regression analysis
was performed to test which variable made prescription more or less likely. RESULTS: There
were 10 455 patients with angina. Blood pressure readings were available for 73.8% of pa-
tients; in this group 58.9% had inadequate (> or = 140/90 mmHg) blood pressure control.
Total cholesterol was recorded in 61.6% of cases (mean value = 5.5 mmol/L). Antiplatelet
or oral anticoagulant agents were used by 67.8% of the patients, while 24.1% of patients
received lipid-lowering agents, 61% received ACE-inhibitors or angiotensin-II receptor anta-
gonists, and 25.2% received beta-blockers. CONCLUSIONS: In patients treated with nitrates
the monitoring of modifiable risk factors and the use of preventive drugs is lower than
expected. New strategies aimed at improving secondary cardiovascular prevention among
these easily identifiable high-risk subjects are needed.
38. Filippi A, Buda S, Brignoli O, Cricelli C, Degli Esposti E. Global cardiovascular risk eva-
luation in italy: a cross sectional survey in general practice. It Heart J. 2004;5:223-7.
ABSTRACT. BACKGROUND: The aim of our work was to evaluate, in a general practice
setting, the attitude of general practitioners in determining the individual coronary risk.
METHODS: The coronary risk was determined among patients aged 30 to 74 years using the
following parameters: gender, age, smoking habits, diagnosis of diabetes mellitus, systolic
blood pressure, and total cholesterol. We evaluated the records of 446,331 subjects collec-
ted by 481 general practitioners working throughout Italy. RESULTS: Except for age, gender
and diabetes mellitus, risk factors were largely under-recorded: blood pressure in 37.0%
of the total patients, total cholesterol in 34.3%, smoking habits in 21.9%. Recording was
substantially low even in patients who were prescribed with antihypertensive drugs and/or
lipid-lowering drugs: blood pressure in 80.6% of the patients, total cholesterol in 69.1%,
smoking habits in 46.1%. Cardiovascular risk factors were more frequently recorded as age
increased and slightly more among women as compared to men. Obviously, it is possible
that risk factors had been assessed but not recorded. CONCLUSIONS: Cardiovascular risk
factors are substantially under-recorded among Italian general practitioners thus impairing
adequate preventive treatment. A systematic, well programmed approach may theoretically
lead to evaluate the majority of the target population within a few years.
39. Fabiani L, Giovannoni S, Casanica M, Scatigna M, Pulsoni R, Ventriglia G, Marchi M.
Applicabilitą di linee guida e formazione: un percorso diagnostico per il mal di
. Rec Prog Med. 2004; 95:81-6.
ABSTRACT. BACKGROUND: The Italian National Health Plan has included low back pain
(LBP) among the pathologies for which clinical guidelines should be created and dissemi-
nated. A change in the clinical behaviour of doctors requires forms of intervention whose
efficiency is not fully known. OBJECTIVES: This study proposes to evaluate the efficacy of
a multifaceted intervention, including educational materials, lectures, workshops and local
consensus processes, in order to modify the General Practitioners' (GP) clinical treatment of