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22 April 2008
Implementing CVD risk assessment in Primary Care
Julia Hippisley-CoxDepartment of Health
22nd April 2008
22nd April 2008 QRisk © 2008 All rights reserved
Objectives
Thoughts on presenting risk to patients
Practical aspects of implementing CVD risk assessment in Primary Care
Patient ‘e’ record access - current realities & future vision
22nd April 2008 QRisk © 2008 All rights reserved
Presenting risk to patients
Patients need to know What is my risk of developing CVD? What can I do to reduce my risk? How effective will this be?
22nd April 2008 QRisk © 2008 All rights reserved
How best to present risk?
Keep it clear & simple Pictures say a thousand words Absolute AND relative risk Present in context of every day
things Give appropriate perspective “The bad news is your risk has doubled --- the good news
is its gone from one in a million to two in a million…..”
22nd April 2008 QRisk © 2008 All rights reserved
What is my risk?
CVD risk of 20% over 10 years Take a 100 people like you, and 20
will develop CVD over the next 10 years
(and 80 people wont!) Easier to understand than “one in
five”
22nd April 2008 QRisk © 2008 All rights reserved
How do I compare? Your risk is three times that of an
average risk for a person of your age/sex
0
5
10
15
20
25
30
My risk Average risk Risk with Rx
22nd April 2008 QRisk © 2008 All rights reserved
Effect of interventions
For smokers: what if stop smoking For overweight: what if loose weight High lipids: what if take statins BP treatment: what if BP treated If you do all of theseBut modelling the ‘what if’s” complex
22nd April 2008 QRisk © 2008 All rights reserved
CVD Risk Assessment Tool Kit On line web calculator for patients for
self assessment Downloadable risk calculator for docs Risk stratification tools for primary care MUST be v simple to use, quick,
accessible and make best use existing data
MUST get the RIGHT people and not widen health inequalities
22nd April 2008 QRisk © 2008 All rights reserved
Risk stratification tool kit –key goals
Utilities for all general practices to to auto-generate a risk recall
register based on ‘estimated risk’ Calculate an `actual risk’ within
the consultation Present risk and discuss effect of
interventions to patients
22nd April 2008 QRisk © 2008 All rights reserved
Risk stratification/recall list
Computer search to calculate score for all patients 35-74
Uses estimated values for SBP, BMI, cholesterol/hdl ratio where missing
Rank all patients and highlight which patients need what interventions
22nd April 2008 QRisk © 2008 All rights reserved
Clinical calculation actual risk
Utility to calculate ‘actual’ risk in consultation and present it back to patients
Explain likely effectiveness of interventions
22nd April 2008 QRisk © 2008 All rights reserved
Personalised plan & printable prescriptions
Item My risks My goals My actions
10 year risk of CVD 27 % (ie 27 out of 100)
Reduce this by half More exerciseSee GP 2 months
Smoking 20 /day Stop smoking Attend new leaf
Blood pressure 155/87mmHg Lower it < 140/90mmHg
Take tablets
Body mass index 37 kg/m2 Ideal <26 Loose weightattend weight group
Cholesterol 6.2 mmols/l Ideal <5mmols/l Low fat diettake statins if no better
eGFR (kidney test) 58 >89 Need further tests
Random Glucose 7.3mmols/l <6mmols/l Need further tests
22nd April 2008 QRisk © 2008 All rights reserved
Quote from a GP in London
“Obviously, the knowing the absolute risk reduction from treatment is essential for a patient to make an informed decision as to whether or not to accept treatment . We are currently doing them a great disservice, by not providing them with better information”.