ESC Preventive Cardiology section expresses preference for CV risk prediction toolNews - June 26, 2019
A paper published in the European Journal of Preventive Cardiology considered the benefits and limitations of various online CV risk calculators. The paper lists the freely accessible online tools for estimating CV prognosis. For each, it details which patient group and geographical region it can be used for, and the outcomes it predicts.
Prevention of CVD is a lifelong endeavour and motivation to continue taking pills and have a healthy lifestyle may be low if there are no symptoms. European guidelines recommend use of risk prediction tools that provide objective information on outcome probabilities. Some tools have been developed to predict 10-year CV mortality risk, while others aim to assess lifetime risk. Different populations require different risk prediction tools. They can guide treatment decisions about the initiation or adjustment of preventive medication. Nevertheless, risk prediction tools are not adequately implemented in clinical practice.
Risk prediction tools facilitate risk communication with the patient and their family, which may increase commitment and motivation to improve health. Seeing the projected benefit of taking preventive medication may be a good incentive.
The article describes what aspects make a risk prediction algorithm into one of good quality and user-friendly. CV risk prediction in various patient groups are considered, including potential caveats. Relevant considerations for assessing risk in older patients, patients younger than 50 years, and high-risk patients are discussed. Subsequently, seven considerations are outlined on how to select the best prediction tool for every patient. The available risk prediction tools are summarised in an overview, with strengths and weaknesses.
Based on these considerations, the EAPC formulates a preference for the U-Prevent tool. This tool is a free interactive website, that encompasses risk calculators for all categories of patients, including healthy people without CVD, vascular patients, patients with T2DM and an elderly-specific score for people over the age of 70 years. U-Prevent can be used to calculate 5- and 10-year risk of CVD and the lifetime treatment effect of specific drugs on CVD-free life expectancy.
For assessment of CVD risk in a healthy population, EAPC advises the use of HeartScore, which is the interactive version of the SCORE risk charts, available in 17 languages.
“Risk prediction tools assess prognosis in an objective and unbiased way,” said author Dr Xavier Rossello, of the Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. “This should avoid both over- and under-treatment and lead to the best outcomes and use of resources. Traditional methods rely on clinical judgement, experience, and personal beliefs and are therefore inconsistent and may be inaccurate.”
The paper is a result of the ESC Prevention of Cardiovascular Disease Programme run by the European Association of Preventive Cardiology (EAPC) in collaboration with the Association of Cardiovascular Nursing and Allied Professions (ACNAP) and the Acute Cardiovascular Care Association (ACCA). It is also published in European Heart Journal – Acute Cardiovascular Care and the European Journal of Cardiovascular Nursing