Systematic Review of Guidelines on Cardiovascular Risk Assessment

Ferket, Bart S.; Çölkesen, Ersen B.; Visser, Jacob J.; Spronk, Sandra; Kraaijenhagen, Roderik A.; Steyerberg, Ewout W.; Hunink, M. G. Myriam

doi:10.1001/archinternmed.2009.434

Cited by 120 publications

(67 citation statements)

References 60 publications

(25 reference statements)

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“…Current guidelines for cardiovascular disease (CVD) prevention recommend absolute risk (AR) assessment to guide the use of preventive medication (Ferket et al, 2010). One of the most commonly used models is the Framingham risk equation, using age, gender, smoking, diabetes, systolic blood pressure and cholesterol ratio to estimate the risk of a cardiovascular event over the next 5 or 10 years (Anderson, Odell, Wilson, & Kannel, 1991;D'Agostino et al, 2008).…”

Section: How Do General Practitioners and Patients Make Decisions Abomentioning

confidence: 99%

How do general practitioners and patients make decisions about cardiovascular disease risk?

Bonner¹,

Jansen²,

McKinn³

et al. 2015

Health Psychology

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Objective: Although current guidelines around the world recommend using absolute risk (AR) thresholds to decide whether cardiovascular disease (CVD) risk should be managed with lifestyle or medication, the use of AR in clinical practice is limited. The aim of this study was to explore the factors that influence general practitioner (GP) and patient decision making about CVD risk management, including the role of risk perception. Methods: Qualitative descriptive study involving semi-structured interviews with 25 GPs and 38 patients in Australia in 2011-2012. Transcribed audio-recordings were thematically coded and a Framework Analysis method was used. Results: GPs rarely mentioned AR thresholds but were influenced by their subjective perception of the patient’s risk and motivation, and their own attitudes toward prevention, including concerns about medication side effects and the efficacy of lifestyle change. Patients were influenced by individual risk factors, their own motivation to change lifestyle, and attitudes toward medication: initially negative, but this improved if medication was more effective than lifestyle. High perceived risk led to medication being recommended by GPs and accepted by patients, but this was not necessarily based on AR. Patient perceptions of high risk also increased motivation to change lifestyle, particularly if they were resistant to the idea of taking medication. Conclusions: Perceived risk, motivation, and attitudes appeared to be more important than AR thresholds in this study. CVD risk management guidelines could be more useful if they include strategies to help GPs consider patients’ risk perception, motivation, and attitudes as well as evidence-based recommendations.

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Section: How Do General Practitioners and Patients Make Decisions Abomentioning

confidence: 99%

How do general practitioners and patients make decisions about cardiovascular disease risk?

Bonner¹,

Jansen²,

McKinn³

et al. 2015

Health Psychology

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show abstract

“…Clinical guidelines around the world advocate CVD risk assessment based on “absolute risk”—the percentage risk of a cardiovascular event over a 5- or 10-year timeframe [7]. The Framingham model is commonly used and accounts for the effect of non-modifiable risk factors, including age and gender, as well as modifiable risk factors, such as smoking, blood pressure, and cholesterol [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Nor have there been any studies investigating the best way to present heart age. This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations [8,9], which are used in clinical practice guidelines in many countries around the world [3,7,20,21]. …”

Section: Introductionmentioning

confidence: 99%

I Don't Believe It, But I'd Better Do Something About It: Patient Experiences of Online Heart Age Risk Calculators

Bonner¹,

Jansen²,

Newell³

et al. 2014

J Med Internet Res

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BackgroundHealth risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to “heart age”, where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age.ObjectiveThis study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world.MethodsGeneral practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to “think aloud” while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used.ResultsRisk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results.ConclusionsOnline heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.

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“…Implementation of low-quality CPGs is unethical, not only in terms of allocation of resources [10]. Health care providers should make use of the best practices with a higher AGREE score (The Appraisal of Guidelines for Research and Evaluation) and avoid documents in which they see a conflict of interests [11]. The low quality of CPGs reduces their effectiveness in improving the quality of health care [12].…”

Section: Theorymentioning

confidence: 99%

Analysis of clinical practice guidelines for cardiovascular disease prevention

Doležel¹,

Jarošová²

2015

Kontakt

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n u r s i n g k o n t a k t 1 7 ( 2 0 1 5 ) e 9 6 -e 1 0 2 a b s t r a c t Cardiovascular diseases remain the leading cause of deaths and one of the most common causes of hospitalization in the Czech Republic. Due to the high increase in cardiovascular diseases, preventive measures to eliminate them were defined. One of the methods of prevention is the systematic clinical practice guideline focused on identifying and influencing cardiovascular risks. The aim of the survey study is to analyze the existing clinical practice guidelines aimed at preventing cardiovascular diseases. On the basis of keywords and specific criteria for the research strategy and classification, the researchers searched in electronic databases and websites of professional companies systematically all available clinical practice guidelines aimed at preventing cardiovascular diseases published between the years 2003-2013. Defined entry criteria were met by twelve clinical practice guidelines. There were four documents excluded on the basis of the specific exclusion criteria. The process of analysis was applied to eight clinical practice guidelines. The analysis was performed in preventive measures, methods of determining and influencing cardiovascular risk, implemented scoring system, sub-components of non-pharmacological interventions, the level of evidence, grades of recommendation and scope of the document. Given the socio-economic and organizational conditions in the Czech Republic, the most appropriate seem to be the clinical European guidelines on cardiovascular disease prevention in clinical practice (European Society of Cardiology), which were primarily designed for European countries. The European recommendations are also reflected by the Czech Clinical Guidelines for Prevention of Cardiovascular Diseases with a specific algorithm for determining cardiovascular risk in Czech population.

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Systematic Review of Guidelines on Cardiovascular Risk Assessment

Abstract: Differences among the guidelines imply important variation in allocation of preventive interventions. To make informed decisions, physicians should use only the recommendations from rigorously developed guidelines.

Cited by 120 publications

References 60 publications

How do general practitioners and patients make decisions about cardiovascular disease risk?

How do general practitioners and patients make decisions about cardiovascular disease risk?

I Don't Believe It, But I'd Better Do Something About It: Patient Experiences of Online Heart Age Risk Calculators

Analysis of clinical practice guidelines for cardiovascular disease prevention

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