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GPs 'sceptical' about cardiovascular polypill benefits

Most GPs are concerned about about the use of the polypill for primary prevention of cardiovascular disease in patients of a certain age, concludes a quantitative analysis.

The study

A total of 11 primary care practices in Birmingham participated in a qualitative study, with 11 GPs and five practice nurses agreeing to an interview at their practice. Interviews covered their understanding of the polypill, their attitude towards its use and prescribing and monitoring the drug.

The findings

All 16 interviewees expressed a concern about using the polypill for primary prevention for everyone over a specific age. One GP was quoted as saying ‘it should only be for those at risk of cardiovascular attack…especially if there’s any history of cardiovascular disease in the family.’ Other causes for concern included a lack of evidence demonstrating effectiveness and a belief that it should only be for those with risk factors, one held by 10 of the 16 professionals interviewed. ‘The polypill should only be for those at risk of a cardiovascular attack….especially if there’s any history of cardiovascular disease in the family,’ was a response quoted by one of the GPs. All bar one participant felt it was necessary to monitor patients regularly, and the idea of minimal monitoring did not sit easily with many.

What does it mean for GPs?

The UK researchers concluded that ‘healthcare professionals were sceptical about the role of a polypill,’ explaining that a ‘major concern was they did not feel the evidence base for a polypill had been established.’ They reported a ‘greater willingness’ for its use for secondary prevention, but with the ‘same provisos about wanting to continue monitoring.’

Expert comment

Dr John Ashcroft, GP in Ilkeston and member of the Derbyshire CHD committee: ‘The central issue is that the Polypill is much more than just a tablet with a statin, two or three hypertensives and maybe aspirin or other drugs, its a concept. And its a concept to reduce treatment populations, a public health concept. As such it may treat some with little risk or “overtreat” some, but it would mean that the huge numbers who are undertreated at present receive treatment that would prevent tens of thousands of deaths every year. The big issue remains that the way we are doing things doesn’t deliver the benefits that are there for patients. So NICE stated in CG67 that all over-75s were eligible for statins, but probably little more than 20% receive them. We treat patients with statins only when they are over 20% 10-year risk. The Americans have been treating to 10% risk for 10 years.’

BMJ 2013, online 4 April

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