A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients’ modifiable risk factor profile

Abstract

Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease (CHD) risk could lower patients' predicted Framingham CHD risk vs. usual care. Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospective, controlled, cluster-randomised trial in nine European countries, among patients at moderate cardiovascular risk. Following baseline assessments, physicians in the intervention group calculated patients' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme. Usual care physicians did not calculate patients' risk and provided usual care only. The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care. Results Of 1103 patients across 100 sites, 524 patients receiving intervention, and 461 receiving usual care, were analysed for efficacy. After 6 months, mean predicted risks were 12.5% with intervention, and 13.7% with usual care [odds ratio = 0.896; p = 0.001, adjusted for risk at baseline (17.2% intervention; 16.9% usual care) and other covariates]. The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention (25.4%) than usual care (14.1%; p < 0.001), and 29.3% of smokers in the intervention group quit smoking vs. 21.4% of those receiving usual care (p = 0.04). Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients' modifiable risk factor profile, and lowered predicted CHD risk compared with usual care. By combining this strategy with more intensive treatment to reduce residual modifiable risk, we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice.

Could clinical decision rules relying on cardiovascular risk models increase psychosocial inequalities in health? Results from the PRIME cohort study

“…Few studies have evaluated the impact of using global cardiovascular risk assessment in clinical practice. These studies reported either moderate effects (a modest increase in drug prescription or reduction in risk factors), or a lack of effect (Benner et al, 2008;Brindle et al, 2006;Sheridan and Crespo, 2008;van Steenkiste et al, 2008). Our results showed that if cardiovascular clinical decision rules relying on global cardiovascular risk assessment could improve health outcome, the use of biomedical risk functions without consideration of psychosocial status could increase health inequalities in depressive subjects.…”

Electronic Health Record-Based Patient Identification and Individualized Mailed Outreach for Primary Cardiovascular Disease Prevention: A Cluster Randomized Trial

“…Other CVD primary prevention studies achieved larger effects but required greater resources, and many included multiple contacts with clinicians. 8,10,11,[21][22][23][24] If a measurable positive effect of a more limited intervention like ours can be accomplished at a sufficiently low cost, it may be a worthwhile approach to adopt. If the process of delivering these messages can be fully automated (such as using a patient portal connected to the electronic health record), this may reduce the cost of providing this service further.…”

A Randomized Trial of Peer Coach and Office Staff Support to Reduce Coronary Heart Disease Risk in African-Americans with Uncontrolled Hypertension

“…It is possible that physicians need to reinforce messages in order achieve a significant reduction in CHD risk as reported in other studies. 16 For this study, we used the 4-year CHD risk model developed by D'Agostino and colleagues from Framingham data. 15 It has the advantage of being applicable to all patients because it calculates risk of either a primary or a secondary CHD event.…”

“…Baseline 10-year risk was 17 % with a calculated standard deviation of 0.07 % for the intervention group (n=524). 16 For our 4-year risk outcome, we assumed a 7 % baseline risk with standard deviation of 0.035 %. To be able to detect a 20 % relative risk reduction, a sample size of 105 subjects per group achieves 80 % power (two-sided Mann-Whitney test) with α=0.05.…”

“…Three African-American staff members (medical assistant, licensed practical nurse, and chronic disease health educator) were trained in practice-based counseling with the 12 slideshows used to train peer coaches and trained to demonstrate the impact of reducing personal CHD risks using an interactive computer 4-year risk 15 calculator modeled after a 10-year CHD risk program 16 (available on request).…”