Can Computerized Risk Profiles Help Patients Improve Their Coronary Risk? The Results of The Coronary Health Assessment Study (CHAS)

Lowensteyn, Ilka; Joseph, Lawrence; Levinton, Carey; Abrahamowicz, Michał; Steinert, Yvonne; Grover, Steven A.

doi:10.1006/pmed.1998.0351

Cited by 70 publications

(94 citation statements)

References 16 publications

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“…There are no other reviews on the use of CAHTS for the prevention of cardiovascular disease. Other studies (43,53,41,32,54,7) assessed the use of CAHTS on cardiovascular disease prevention and management, but these either did not compare oral to written history taking processes or were conducted in participants who did have pre-existing cardiovascular disease. In agreement with our findings they generally found that computer-assisted methods improved the prevention or management of patients with cardiovascular disease or with risk factors for cardiovascular disease.…”

Section: Cahts For Cvd Preventionmentioning

confidence: 99%

“…The study showed improvements in the quality of lipid management after implementing an electronic disease management intervention in primary care. Lowensteyn et al (1988) found improved identification of patients at high-risk of cardiovascular disease when computer-generated risk profiles were used. Their use was also associated with a significantly greater improvement in serum lipid profiles and overall coronary risks.…”

Section: Cahts For Cvd Managementmentioning

confidence: 99%

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Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Pappas

Všetečková

Poduval

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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A B ST R AC T Background and objectives: CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: -Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD.-Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. Methods: A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. Results: Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The ComputerAssisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. Discussion: With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. Conclusions: We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.

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Section: Cahts For Cvd Preventionmentioning

confidence: 99%

Section: Cahts For Cvd Managementmentioning

confidence: 99%

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Pappas

Všetečková

Poduval

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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“…44,[51][52][53][54] These trials are noteworthy for considerable heterogeneity of methodology, both in terms of the intervention provided and the end point assessed. The majority have shown greater reductions in risk factor levels in those randomized to intervention, 44,53,54 which was either provision of a risk-estimation system (for the healthcare provider to use) or a summary of the patient's total CVD risk displayed in the chart, although the results have not been entirely consistent. 51,55 The majority of these trials have not been able to account for the reduction in unnecessary prescription of medications to lower-risk individuals because they have included only higher-risk individuals.…”

Section: Do Risk-estimation Systems Make a Difference?mentioning

confidence: 99%

“…51,55 The majority of these trials have not been able to account for the reduction in unnecessary prescription of medications to lower-risk individuals because they have included only higher-risk individuals. 44,51,53,55 However, the study by Hall et al 51 showed that within the intervention group, there was an increase in prescription of preventive medications to highrisk individuals without a change in the low-risk group.…”

Section: Do Risk-estimation Systems Make a Difference?mentioning

confidence: 99%

Cardiovascular Risk-Estimation Systems in Primary Prevention

et al. 2010

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“…Moreover, utilization of an outcome framework provides data that can directly measure the effectiveness of physicians in achieving health outcome targets for the population, and identify suboptimal or variable aspects of management that could be targeted for professional development and policy intervention. Indeed, physicians are already using predictive statistical models in practice to calculate risk, assess prognosis, and assist patients in reducing their risk of adverse events 5,6 .…”

mentioning

confidence: 99%

Protecting the Public: Is It Time for a Paradigm Shift in Expected Practice Standards?

Tamblyn

2011

J GEN INTERN MED

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Can Computerized Risk Profiles Help Patients Improve Their Coronary Risk? The Results of The Coronary Health Assessment Study (CHAS)

Cited by 70 publications

References 16 publications

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Cardiovascular Risk-Estimation Systems in Primary Prevention

Protecting the Public: Is It Time for a Paradigm Shift in Expected Practice Standards?

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