Cardiovascular Disease Risk Assessment Tools Research Articles

Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management.

Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half (n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

Impact of Individual and Neighborhood Factors on Cardiovascular Risk in White Hispanic and Non-Hispanic Women and Men.

Cardiovascular disease (CVD) is the leading cause of mortality for adults in the US, regardless of ethnicity. A cross-sectional correlational design was used to describe and compare CVD risk and cardiac mortality in White Hispanic and non-Hispanic women and men. Data from 3,317 individuals (1,523 women and 1,794 men) hospitalized for non-cardiac causes during 2012-2013, and data from the 2010 United States Census were included. The sex-specific 10-year Framingham General Cardiovascular Risk Score (FRS-10) was used to estimate long-term risk for major cardiac events. Approximately three-quarters of the sample was White Hispanic. FRS-10 scores were generally low, but a high prevalence of risk factors not included in the standard FRS-10 scoring formula was seen. White Hispanic women had significantly lower estimated CVD risk scores compared to White Hispanic and non-Hispanic men despite higher non-FRS-10 risks. Neighborhood median household income had a significant negative relationship and Hispanic neighborhood concentration had a significant positive relationship with cardiac mortality. Hispanic concentration was the only predictor of estimated CVD risk in a multilevel model. CVD risk assessment tools that are calibrated for ethnic groups and socioeconomic status may be more appropriate for Hispanic individuals than the FRS-10. Neighborhood-level factors should be included in clinical cardiac assessment in addition to individual characteristics and behavioral risks. Researchers should continue to seek additional risk factors that may contribute to or protect against CVD in order to close the gap between estimated CVD risk and actual cardiac mortality for Hispanics in the US. © 2016 Wiley Periodicals, Inc.

Prevalence and Risk of Osteoporosis and Cardiovascular Disease in Rajasthani Post Menopausal Women

Osteoporosis and cardiovascular disease (CVD) are a major growing public health problem with impact that crosses medical, social and economic lines. The aim of this study was to assess the prevalence and risk of osteoporosis and CVD in post menopausal women. A cross sectional study was conducted on 322 post menopausal women aged 45-55 years residing in Udaipur city, Rajasthan. Risk of osteoporosis in subjects was assessed using Osteoporosis Self Assessment Tool for Asian (OSTA) and risk of CVD was determined using CVD risk assessment tool. The body weight and age of subjects were calculated for the OSTA index sore. Total cholesterol, high density lipoprotein, diastolic blood pressure and smoking habits of subjects were assessed for CVD risk score. Results of OSTA assessment revealed that 24.22 % respondents were at medium risk of osteoporosis whereas results of CVD assessment showed that a large number of subjects i.e. 82.91 % were at medium risk of CVD. Combining both the assessment scores of subjects, 23.91 % post menopausal women were found at medium risk of both osteoporosis and CVD. Study showed a lower prevalence of osteoporosis having medium risk and higher prevalence of CVD having moderate risk in post menopausal women. The findings suggest that more studies should be done on these at risk population for preventive and therapeutic interventions.

Cardiovascular Disease Risk Assessment Tools in HIV-Infected Patients - Are They Adequate?

Cardiovascular disease (CVD) has become one of the leading causes of morbidity and mortality among HIVinfected patients with seropositive patients developing CVD at higher rates than seronegative patients. Therefore, it is critical to have inexpensive, non-invasive assessment tools for CVD risk assessment in HIV-infected patients. Nearly all CVD risk assessment tools were derived from the general population, and their ability to predict CVD in the HIV population has been variable. In order to more accurately predict CVD risk in HIV-infected patients, a new CVD risk assessment tool derived from the HIV population that accounted for factors specific to HIV infection, disease course, and/or sequelae of treatment with antiretroviral therapy is needed. An improved CVD risk assessment tool for HIVinfected patients will help determine which patients would most benefit from primary prevention strategies.

Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes.

Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries.

Applicability of the Existing CVD Risk Assessment Tools to Type II Diabetics in Oman: A Review

Patients with type II diabetes (T2DM) have an elevated risk for cardiovascular disease (CVD), and it is considered to be a leading cause of morbidity and premature mortality in these patients. Many traditional risk factors such as age, male sex, hypertension, dyslipidemia, glycemic control, diabetes duration, renal dysfunction, obesity, and smoking have been studied and identified as independent factors for CVD. Quantifying the risk of CVD among diabetics using the common risk factors in order to plan the treatment and preventive measures is important in the management of these patients as recommended by many clinical guidelines. Therefore, several risk assessment tools have been developed in different parts of the world for this purpose. These include the tools that have been developed for general populations and considered T2DM as a risk factor, and the tools that have been developed for T2DM populations specifically. However, due to the differences in sociodemographic factors and lifestyle patterns, as well as the differences in the distribution of various CVD risk factors in different diabetic populations, the external applicability of these tools on different populations is questionable. This review aims to address the applicability of the existing CVD risk models to the Omani diabetic population.

Integration of Different Risk Assessment Tools to Improve Stratification of Patients with Coronary Artery Disease.

Cardiovascular disease (CVD) causes unaffordable social and health costs that tend to increase as the European population ages. In this context, clinical guidelines recommend the use of risk scores to predict the risk of a cardiovascular disease event. Some useful tools have been developed to predict the risk of occurrence of a cardiovascular disease event (e.g. hospitalization or death). However, these tools present some drawbacks. These problems are addressed through two methodologies: (i) combination of risk assessment tools: fusion of naïve Bayes classifiers complemented with a genetic optimization algorithm and (ii) personalization of risk assessment: subtractive clustering applied to a reduced-dimensional space to create groups of patients. Validation was performed based on two ACS-NSTEMI patient data sets. This work improved the performance in relation to current risk assessment tools, achieving maximum values of sensitivity, specificity, and geometric mean of, respectively, 79.8, 83.8, and 80.9%. Additionally, it assured clinical interpretability, ability to incorporate of new risk factors, higher capability to deal with missing risk factors and avoiding the selection of a standard CVD risk assessment tool to be applied in the clinical practice.

Making the case for a more accurate cardiovascular disease risk assessment tool for Indigenous Australians.

Cardiovascular Disease (CVD) is the leading cause of premature death in Indigenous Australians (Australian Indigenous HealthInfoNet, 2014). Statistics show that the morbidity and mortality from CVD...

Prioritizing health outcomes in a limited world: writing lipid guidelines.

Guidelines are increasing in importance as healthcare becomes standardized. This article examines the processes by which the new US American College of Cardiology-American Heart Association and UK National Institute of Health and Care Excellence lipid guidelines came to their conclusions and how the nature of the evidence base and health economics contributed to the recommendations made. The writing of guidelines is becoming a systematic formal process with increasing emphasis on maintaining integrity, minimizing conflicts of interest and using consistent systematic methods to define the evidence base, grade its quality and then make recommendations. These processes are illustrated by showing why new cardiovascular disease risk assessment tools were required, what recommendations could be made about diet and lifestyle, why a fixed-dose drug treatment protocol as opposed to a target-based approach was recommended for the management of patients in secondary prevention, diabetes and primary prevention and how these would impact clinical practice. Modern systematic evidence assessment and economic appraisal convincingly favour the use of lipid-lowering drugs especially statins at higher doses than currently prescribed in secondary prevention and at lower risk thresholds in primary care than previously imagined. As long-term adherence to treatment is required patient choice is key to realizing the benefits of these interventions.

Making the case for a more accurate cardiovascular disease risk assessment tool for Indigenous Australians

Making the case for a more accurate cardiovascular disease risk assessment tool for Indigenous Australians

心血管疾病风险评估研究的概况

心血管疾病因其高发病率、高致死率，成为世界范围内最大的疾病负担。作者通过查阅国内外大量相关文献，比较目前常用的心血管病风险评估工具如Framingham风险评估、美国胆固醇教育计划成人治疗组第三次指南(NCEP ATP III)、欧洲系统性冠心病风险评估、英国QRISK心血管风险评估、Reynolds风险评分等，发现CVD风险评估模型随着风险因素的不断发现而不断完善，同时也存在不同程度的局限性。我国尚缺乏对CVD进行全面系统、综合传统风险因素和遗传因素的有效风险评估手段，进而提出将中医四诊信息客观参数运用到CVD风险因素评估中,以期为我国疾病风险评估研究提供新的思路。 Cardiovascular diseases become the biggest burden of disease worldwide because of its high inci-dence and mortality. By collecting a large number of related literatures and comparing the present commonly used cardiovascular disease risk assessment tools such as Framingham risk assessment, the United States cholesterol program adult treatment group report (NCEP ATP III), Systematic Coronary Risk Evaluation in Europe, the British QRISK cardiovascular risk algorithm, Reynolds Risk Score and so on, we find that CVD risk assessment models are continuously improved with more risk factor being found and also there are different degrees of limitations. As the effective and comprehensive risk assessment of CVD, which takes conventional risk factors and genetic factors into consideration, is not available in China, we thus put forward the new research thinking that combines traditional Chinese medical method, information from TCM Four diagnostic methods, with CVD risk assessment to study the risk assessment of disease in our country.

Personalization algorithms applied to cardiovascular disease risk assessment.

Cardiovascular disease (CVD) is the major cause of death in the world. Clinical guidelines recommend the use of risk assessment tools (scores) to identify the CVD risk of each patient as the correct stratification of patients may significantly contribute to the optimization of the health care strategies. This work further explores the personalization of CVD risk assessment, supported on the evidence that a specific CVD risk assessment tool may have good performance within a given group of patients and might perform poorly within other groups. Two main personalization methods based on the proper creation of groups of patients are presented: i) clustering patients approach; ii) similarity measures approach. These two methodologies were validated in a Portuguese population (460 Acute Coronary Syndrome with non-ST segment elevation (ACS-NSTEMI) patients). The similarity measures approach had the best performance, achieving maximum values of sensitivity, specificity and geometric mean of, respectively, 77.7%, 63.2%, 69.7%. These values represent an enhancement in relation to the best performance obtained with current CVD risk assessment tools applied in clinical practice (78.5%, 53.2%, 64.4%).

Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers

BackgroundPrimary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate its impact on CHW training and the duration of screening for CVD in the community by CHWs. MethodsA feature phone application was developed using the open source online platform, CommCare©. CHWs (n=24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10–20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools. ResultsThe training time was 12.3h for the paper-based chart tool and 3h for the mobile phone application. 537 people were screened. The mean screening time was 36min (SD=12.6) using the paper-base chart tool and 21min (SD=8.71) using the mobile phone application, p=<0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study. ConclusionThe reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.

Cardiovascular risk and inflammatory rheumatic diseases

#### Key points Regular assessment of cardiovascular disease (CVD) risk factors is strongly recommended Standard CVD risk assessment tools are not appropriate for estimating CVD risk for patients with systemic lupus erythematosus (SLE) as they significantly underestimate the actual risk For

Abstract 314: Systematic Inquiry of Family History Improves Cardiovascular Disease Risk Assessment

Background: Numerous research publications substantiate the value of family history of premature cardiovascular disease (CVD) as an independently predictive risk factor for CVD. However, many traditional CVD risk assessment tools do not incorporate family history and therefore underestimate true risk. Risk assessment is the cornerstone of determining therapeutic goals and preventive intervention. Objective: We sought to implement and validate a clinical decision support tool that incorporates family history as a high-risk factor to guide risk stratification in a population identified as low and intermediate risk by Framingham Risk Score (FRS). Methods: In a retrospective analysis of patients entering our CVD prevention program, the clinical decision support tool was applied. The clinical decision support tool defines family history of premature CVD as having a parent and/or sibling with a CVD event before the age of 65. Patients entering our CVD prevention program have a comprehensive risk assessment including measurement of blood pressure, lipids, glucose metabolism and Carotid Intima Media Thickness (CIMT). Results: Of 394 patients entering our program, 239 (61%) were scored as low or intermediate risk by FRS. These patients had a mean age of 49 years (range 20-76), 60% women, 52% Caucasian, 37% Black, 5% Hispanic and 6% other. The decision support tool identified 114 (48%) of these patients as high-risk for CVD as a result of the inclusion of family history of premature CVD. In these patients, 72% had dyslipidemia, 35% hypertension, 20% prediabetes and 61% had early atherosclerotic disease by CIMT. Conclusions: In our population, almost half of the patients previously determined as low or intermediate risk were reclassified as high-risk for CVD. This reclassification is underscored and validated in view of both the high frequency of metabolic abnormalities revealed and the atherosclerotic plaque burden seen by CIMT. These findings are highly relevant particularly in middle-aged women who are frequently more vulnerable to overt heart disease and require improved risk assessment for aggressive treatment goals to enhance prevention.

Implementation of Spanish adaptation of the European guidelines on cardiovascular disease prevention in primary care

BackgroundThe successful implementation of cardiovascular disease (CVD) prevention guidelines relies heavily on primary care physicians (PCPs) providing risk factor evaluation, intervention and patient education. The aim of this study was to ascertain the degree of awareness and implementation of the Spanish adaptation of the European guidelines on CVD prevention in clinical practice (CEIPC guidelines) among PCPs.MethodsA cross-sectional survey of PCPs was conducted in Spain between January and June 2011. A random sample of 1,390 PCPs was obtained and stratified by region. Data were collected by means of a self-administered questionnaire.ResultsMore than half (58%) the physicians were aware of and knew the recommendations, and 62% of those claimed to use them in clinical practice, with general physicians (without any specialist accreditation) being less likely to so than family doctors. Most PCPs (60%) did not assess cardiovascular risk, with the limited time available in the surgery being cited as the greatest barrier by 81%. The main reason to be sceptical about recommendations, reported by 71% of physicians, was that there are too many guidelines. Almost half the doctors cited the lack of training and skills as the greatest barrier to the implementation of lifestyle and behavioural change recommendations.ConclusionsMost PCPs were aware of the Spanish adaptation of the European guidelines on CVD prevention (CEIPC guidelines) and knew their content. However, only one third of PCPs used the guidelines in clinical practice and less than half CVD risk assessment tools.

Underuse of Aspirin for Primary and Secondary Prevention of Cardiovascular Disease Events in Women

Evidence-based guidelines for use of aspirin to decrease cardiovascular disease (CVD) events in women are well established. Despite this, aspirin is underused in women. We examined self-reported aspirin use in women for primary and secondary prevention of CVD events, correlates of use, and change in use over time from 2004 to 2009. Data from volunteer respondents participating in a web-based CVD risk assessment tool at 127 US healthcare centers were analyzed. Survey questions included information on CVD risk factors, the presence or absence of any form of CVD, diabetes mellitus, and medication usage, including daily aspirin. Logistic regression analyses identified factors associated with aspirin intake. Of the 217,987 women respondents, 29,701 women were recommended to take aspirin based on the guidelines. We found, however, that only 41% of women who meet criteria for primary prevention and 48% of women who meet criteria for secondary prevention report that they take aspirin on a daily basis. The main factors that favored aspirin use were a family history of CVD or high cholesterol. Although aspirin use for secondary prevention did not change between the years 2004 and 2009, there was a significant increase in aspirin use for primary prevention. These findings confirm that the majority of women for whom aspirin is recommended for primary and secondary prevention of CVD were not following national guidelines. Educational programs for clinicians and women aimed at promoting appropriate use of aspirin is one measure that should improve CVD outcomes in women.

Survey of physicians’ practices in the control of cardiovascular risk factors: the EURIKA study

To assess the practices of physicians in 12 European countries in the primary prevention of cardiovascular disease (CVD). In 2009, 806 physicians from 12 European countries answered a questionnaire, delivered electronically or by post, regarding their assessment of patients with cardiovascular risk factors, and their use of risk calculation tools and clinical practice guidelines (ClinicalTrials.gov number: NCT00882336). Approximately 60 physicians per country were selected (participation rate varied between 3.1% in Sweden and 22.8% in Turkey). Among participating physicians, 85.2% reported using at least one clinical guideline for CVD prevention. The most popular were the ESC guidelines (55.1%). Reasons for not using guidelines included: the wide choice available (47.1%), time constraints (33.3%), lack of awareness of guidelines (27.5%), and perception that guidelines are unrealistic (23.5%). Among all physicians, 68.5% reported using global risk calculation tools. Written charts were the preferred method (69.4%) and the most commonly used was the SCORE equation (35.4%). Reasons for not using equations included time constraints (59.8%), not being convinced of their usefulness (21.7%) and lack of awareness (19.7%). Most physicians (70.8%) believed that global risk-equations have limitations; 89.8% that equations overlook important risk factors, and 66.5% that they could not be used in elderly patients. Only 46.4% of physicians stated that their local healthcare framework was sufficient for primary prevention of CVD, while 67.2% stated that it was sufficient for secondary prevention of CVD. A high proportion of physicians reported using clinical guidelines for primary CVD prevention. However, time constraints, lack of perceived usefulness and inadequate knowledge were common reasons for not using CVD prevention guidelines or global CVD risk assessment tools.

Long term cardiovascular risk models’ combination

The correct diagnosis of cardiovascular disease is a key factor to reduce social and economic costs. In this context, cardiovascular disease risk assessment tools are of fundamental importance. This work addresses two major drawbacks of the current cardiovascular risk score systems: reduced number of risk factors considered by each individual tool and the inability of these tools to deal with incomplete information. To achieve these goals a two phase strategy was followed. In the first phase, a common representation procedure, based on a Naïve-Bayes classifier methodology, was applied to a set of current risk assessment tools. Classifiers’ individual parameters and conditional probabilities were initially evaluated through a frequency estimation method. In a second phase, a combination scheme was proposed exploiting the particular features of Bayes probabilistic reasoning, followed by conditional probabilities optimization based on a genetic algorithm approach. This strategy was applied to describe and combine ASSIGN and Framingham models. Validation results were obtained based on individual models, assuming their statistical correctness. The achieved results are very promising, showing the potential of the strategy to accomplish the desired goals.

C-B4-04: Underuse of Aspirin in Women for Primary and Secondary Prevention of Cardiovascular Disease Events

Background and Aims: Cardiovascular disease (CVD) is the leading cause of death among women. Consistent with studies documenting that aspirin (ASA) use decreases the risk of CVD events in certain groups, the American Heart Association (AHA) published specific evidence based guidelines for ASA use in women. This paper evaluates the self-reported use of ASA among women and examined characteristics of those most likely to be adhering to clinical guidelines. Methods: Data from 127 healthcare centers across the U.S. using a commercial, web-based CVD risk assessment tool (HeartAware™) were analyzed. Volunteer respondents answered questions about their CVD risk factors, the presence or absence of coronary, cerebral, peripheral arterial disease, diabetes, and medication use including daily ASA. Individuals who, based on the AHA 2007 guidelines should be taking ASA (for primary and secondary prevention) were included in the analysis. Univariate and multivariate logistic regression analyses were performed to identify factors significantly associated with ASA intake. Results: Of the 21,199 women who should be on ASA based on guideline information, only 42% reported the use for primary prevention and 68% for secondary prevention. Multivariate regression analysis found that African Americans (OR = 0.61, 95% CI 0.53–0.70, p<0.0001) and Hispanics (OR = 0.67, 95% CI 0.53–0.83, p=0.0004) were less likely than Caucasians to be taking ASA. Other factors that contributed significantly (p<0.001) to ASA use were a relationship with a PCP or cardiologist, taking blood pressure medications, past history of smoking, a family history of heart disease, and a family history of high cholesterol. Conclusions: Findings from a large cross-sectional cohort revealed that 58% of women who should be taking ASA for primary prevention and 32% of women who should be taking ASA for secondary prevention of CVD events were not following national guidelines. Individuals from racial/ethnic minorities were less likely to be taking ASA compared with Caucasians suggesting targets for intervention. These findings emphasize the need for ASA education among clinicians to provide guidance for targeting educational efforts that can improve CVD outcomes in women.