Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology

Lloyd‐Jones, Donald M.; Huffman, Mark D.; Karmali, Kunal N.; Sanghavi, Darshak M.; Wright, Janet; Pelser, Colleen; Gulati, Martha; Masoudi, Frederick A.; Goff, David C.

doi:10.1161/cir.0000000000000467

Cited by 110 publications

(98 citation statements)

References 76 publications

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“…In five of the studies in our metasynthesis, women identified a lack of understanding of and attention to their existing knowledge by clinicians, as well as their self-reported health status and health needs as barriers to satisfactory care. 21–23 26 27 While suggestions were made about how shared decision-making could be implemented into cardiovascular care, 29 30 and translated into practice in to national programmes such as the Million Hearts initiative, 31 32 a gendered approach was not considered nor examined in the unique context of various cardiac conditions in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis

et al. 2018

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ObjectiveCardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services.MethodWe conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women’s experiences extracted from each publication to inform new healthcare practices and communication.ResultsEleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences.ConclusionsThere is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.

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Section: Discussionmentioning

confidence: 99%

Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis

et al. 2018

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“…10 Contemporary risk calculators and cost-effectiveness studies also use CTT results in order to estimate the benefits of lipid-lowering therapy. 11-14 …”

Section: Methodsmentioning

confidence: 99%

The Expected Cardiovascular Benefit of Plasma Cholesterol Lowering with or Without LDL-C Targets in Healthy Individuals at Higher Cardiovascular Risk

Cesena

Laurinavicius

Valente

et al. 2017

Arquivos Brasileiros De Cardiologia

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Background:There is controversy whether management of blood cholesterol should be based or not on LDL-cholesterol (LDL-c) target concentrations.Objectives:To compare the estimated impact of different lipid-lowering strategies, based or not on LDL-c targets, on the risk of major cardiovascular events in a population with higher cardiovascular risk.Methods:We included consecutive individuals undergoing a routine health screening in a single center who had a 10-year risk for atherosclerotic cardiovascular disease (ASCVD) ≥ 7.5% (pooled cohort equations, ACC/AHA, 2013). For each individual, we simulated two strategies based on LDL-c target (≤ 100 mg/dL [Starget-100] or ≤ 70 mg/dL [Starget-70]) and two strategies based on percent LDL-c reduction (30% [S30%] or 50% [S50%]).Results:In 1,897 subjects (57 ± 7 years, 96% men, 10-year ASCVD risk 13.7 ± 7.1%), LDL-c would be lowered from 141 ± 33 mg/dL to 99 ± 23 mg/dL in S30%, 71 ± 16 mg/dL in S50%, 98 ± 9 mg/dL in Starget-100, and 70 ± 2 mg/dL in Starget-70. Ten-year ASCVD risk would be reduced to 8.8 ± 4.8% in S50% and 8.9 ± 5.2 in Starget-70. The number of major cardiovascular events prevented in 10 years per 1,000 individuals would be 32 in S30%, 31 in Starget-100, 49 in S50%, and 48 in Starget-70. Compared with Starget-70, S50% would prevent more events in the lower LDL-c tertile and fewer events in the higher LDL-c tertile.Conclusions:The more aggressive lipid-lowering approaches simulated in this study, based on LDL-c target or percent reduction, may potentially prevent approximately 50% more hard cardiovascular events in the population compared with the less intensive treatments. Baseline LDL-c determines which strategy (based or not on LDL-c target) is more appropriate at the individual level.

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“…The GPs wanted to be able to visually show the risk and share information with the patient, and this could also improve the difficulties in gaining a common understanding of the risk and the need for change. The American Heart Association/American College of Cardiology has recently developed a digital cardiovascular risk profile that is relevant for both heart disease and stroke [ 25 ], however lifestyle related risk factors stroke such as low physical activity and unhealthy diet are not included nor addressed. The Stroke risk scorecard [ 26 ] includes lifestyle related risk factors, but the evidence-base is not established yet.…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ reasoning on risk screening and primary prevention of stroke – a focus group study

et al. 2018

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BackgroundBy screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs’ reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care.MethodsA qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups.ResultsFindings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work.ConclusionThere is a need for a more proactive, transparent and systematic approach in the distribution of GPs’ time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0883-6) contains supplementary material, which is available to authorized users.

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Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology

Cited by 110 publications

References 76 publications

Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis

Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis

The Expected Cardiovascular Benefit of Plasma Cholesterol Lowering with or Without LDL-C Targets in Healthy Individuals at Higher Cardiovascular Risk

General practitioners’ reasoning on risk screening and primary prevention of stroke – a focus group study

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