How GPs decide to assess cardiovascular risk factors in European countries – a qualitative EGPRN Fellowship study.

Ilze Skuja, Aleksandra Trubovich, Emilie Femtehjell, Marta Marques, Elina Skuja, Aivars Lejnieks, Michael Harris

Keywords: Primary health care systems. General Practitioners. Cardiovascular risk factors. Decision-making.


Cardiovascular disease (CVD) is the main cause of death in Europe, leading to 3.9 million deaths a year (45% off all deaths). General Practitioners (GPs) are often the first clinicians to be consulted by patients, and they need to assess CVD risk factors (RF) and initiate preventive measures, so that overall prevalence of CVD morbidity and mortality can reduce.

Research questions:

How do GPs think and act when seeing patients who might have CVD RFs?


A semi-structured questionnaire was designed following a literature review. The researchers used this to interview GPs in five countries (Latvia, Portugal, Norway, Russia and England) until there was data saturation. Data were transcribed, translated into English, coded, validated, then divided into themes and sub-themes, with comparisons made across the participating countries.


There were 10 interviews in Latvia, Russia, Norway and Portugal and 8 interviews in England, each lasting 25-45 minutes. Relevant differences between national health care systems included the structure of GPs’ teams and how they are financed. We identified eight overarching themes relating to how GPs assess CVD risk: ranking of the relative importance of different RFs; indications to perform RF assessments; typical profiles of patients that need RF assessment; the effect of obesity; use of guidelines; assessment using SCORE risk charts; limitations and problems associated with CVD risk assessment.


While GPs’ knowledge of CVD RFs are broadly similar across these countries, there are national variations in practitioners’ approach. These differences are driven by variations in financial, historical and geographical factors, as well as specific differences in GPs’ knowledge. However, we found more similarities than differences between the views of GPs in the five countries studied, and these may provide a basis for a Europe-wide primary care approach to acting on CVD risk factors.

Points for discussion:

How can we use our findings to reduce the between-country differences in CVD rates?

How can postgraduate training and other medical education be used to support GP decision-making in patients that may have CVD RFs?