Summary 2

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School

Pennsylvania State University *

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410

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Medicine

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Feb 20, 2024

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docx

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Uploaded by hn101

Introduction CVD risk calculators are often used by primary care physicians to estimate a patient's risk, but only 22-48% of physicians regularly use them. Reasons for this include time constraints, perceived information inconsistency, oversimplification, and subjective risk prediction. Inconsistency among calculators also limits their adoption. A review of 25 calculators found that 33% of the time, the same patient was assigned to different risk categories. The study aimed to determine how different calculators weigh individual cardiovascular risk factors, such as smoking, to improve agreement and avoid disagreements. Methods The study is a sub-study of risk factor increases in CVD and coronary heart disease (CHD) risk calculators. The authors selected and independently selected a broad range of calculators from different countries, data sources, and formats. They excluded seven calculators that did not provide absolute numbers and halved the numbers again, leaving 32 diabetic and 32 non-diabetic patient pairs. The seven risk factors common to all included calculators were age, gender, smoking status, diabetes, systolic BP, total cholesterol, and HDL. To analyze the relative risk increase associated with each risk factor from each calculator, they performed individual risk factor analysis and created pairs of identical patients with the same risk factors. Two authors independently completed the risk assessment for all 128 hypothetical patients on each calculator. Results The study analyzed the relative risk increases of 16 calculators, including 10 for diabetics, non- diabetic patients, and diabetic patients. The mean relative risk increase varied significantly across calculators, with the highest increase for age from 50 to 70 years being 82% for Edinburgh (Framingham, CHD) and 395% for PROCAM (Health Check). For diabetic patients, the highest relative risk increase was 4.9 for age, 18.2 for gender, 3.8 for smoking status, 7.8 for systolic BP, 5.9 for total cholesterol, 4.9 for HDL, and 3.4 for diabetic status. Discussion In a study comparing cardiovascular disease (CVD) risk estimates, differences were found in the increased risk for certain risk factors, with some experts using three risk estimates that were five times higher than others. This study found that risk weighting leads to differences in expected outcomes versus the type of cancer outcome assessed (CVD versus cancer). Conclusion Cardiovascular disease (CVD) risk calculators vary significantly in how much they increase relative risk for specific factors, with the top differing up to 18 times more than the bottom. Some consistently show higher increases in risk (like PROCAM) while others (like ASSIGN from Edinburgh) show lower. Despite the differences, certain calculators, especially those based on the Framingham 10-year CVD data, show more consistent risk increases. Users should be

cautious, as the estimated impact of reducing risk factors on overall risk can differ markedly between calculators. Why is this paper important to the field and how the contributions will advance health knowledge? The variation among cardiovascular risk calculators in relative risk increases with identical risk factor increases is important to the healthcare field because it can lead to inaccurate risk assessments and potentially inappropriate treatment decisions. If different calculators provide different risk estimates for the same patient, it can be difficult for healthcare providers to determine the most appropriate course of action. Understanding the sources of variation among risk calculators can help advance health knowledge by identifying areas for improvement in risk assessment tools. For example, if certain risk factors are consistently weighted differently across different calculators, this could indicate a need for more standardized approaches to risk factor assessment. References Allan, G.M., Kolber, M. R., Korownyk, C., McCormack, J., Nouri, F., & Vandermeer, B. (2015). Variation among cardiovascular risk calculators in relative risk increases with identical risk factor increases. BMC, 8(417). https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-1401-8

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