Cardiovascular Risk Calculator (Absolute CVD Risk)

 

 

 

About the Cardiovascular Risk Calculators

Clinical provides users with two CVD Risk Calculators; an Absolute Risk Calculator, and a Relative Risk Calculator (selectable via associated buttons on the window). This topic is about the Absolute Cardiovascular Risk Calculator.

The Absolute CVD Risk Calculator is an initiative of the Australian  National Vascular Disease Prevention Alliance and is reproduced in Clinical with their permission.

The Calculator is designed to help you asses your patients' risk of cardiovascular disease by analysing multiple risk factors, and providing you with a numerical probability of a CVD event occurring within five years, expressed as a percentage. The calculator is based on specifications outlined in the guide "Functional Specification: Australian Absolute Cardiovascular Disease Risk Calculator (May 2009)", prepared by NPS on behalf of NVDPA; National Prescribing Service Limited. Australian Absolute Cardiovascular Disease Risk Calculator Functional Specifications. Surry Hills: National Prescribing Service Limited, 2009.

Risk parameters used in the Absolute CVD Risk Calculator are based on the Framingham Risk Equation.

 

 


How the Calculator Works

The Cardiovascular Risk Calculator is a calculator only; measurements entered, and values calculated can be saved within the calculator for viewing later, and the result can be saved back to the patient's Progress Notes. It is anticipated that the clinician will decide whether to use the Cardiovascular Risk Calculator based on clinical impression. The calculator then acts at two levels;

Identifying high-risk patients:

o       Cardiovascular disease; coronary heart disease (CHD), stroke and other vascular disease including peripheral arterial disease and renovascular disease. For a list of diagnosis descriptions that trigger automatic exclusion,  see Absolute CVD Risk Diagnosis Descriptions.

o       Patients age ≥ 75 years of age, including patients who identify themselves as ATSI.

o       Patient is diabetic and is of age > 60 years. For a list of diagnosis descriptions that trigger automatic exclusion,  see Absolute CVD Risk Diagnosis Descriptions.

o       Diabetes with microalbuminuria (> 20 mcg/min or urinary albumin:creatinine ratio > 2.5 mg/mmol for males, > 3.5 mg/mmol for females). MedicalDirector Clinical does not currently flag patients with recorded ‘diabetes with microalbuminuria’ as high-risk.

o       Moderate or severe chronic kidney disease (persistent proteinuria or estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m2). Persistence of proteinuria will only be able to be determined by clinical review by the practitioner.

         For a list of diagnosis descriptions that trigger automatic exclusion,  see Absolute CVD Risk Diagnosis Descriptions.

         Persistence of proteinuria will only be able to be determined by clinical review by the GP

 

o       A previous diagnosis of familial hypercholesterolaemia. See ‘Absolute CVD risk Diagnosis Descriptions’.

o       Systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg, as sourced from the most recent blood pressure 'sitting' data, recorded within the last 2 months.

o       Serum total cholesterol > 7.5 mmol/L.

Note: For such patients, you need not enter data into the calculator; you can simply click to automatically document the risk value as >15% in the Tool Box. This will also add a note to the patient's Progress Notes.

 

OR

Calculating absolute cardiovascular disease risk for patients who are:

o       45 to 74 years of age, who are not known to have cardiovascular disease.

o       ATSI patients >34 years of age who are not known to have cardiovascular disease.

 

Notes:

o       Because the calculator gives you an estimate only of the patient's cardiovascular risk, it is recommended that you use it only for patients between 35 and 75 years of age;

         For patients <35 years, the calculator will not attempt to calculate risk, displaying the  message "Cardiovascular risk cannot be accurately determined below the age of 35 or above the age of 74".

         The calculator is of no value to patients 75 years of age or older, as this group is automatically considered 'high risk'.

 

o       Resources for health professionals and consumers are available online, here. The Cardiovascular Risk Calculator tool also displays these links for your convenience, as shown in the example below..

 

 


Recommended Patient Groups

o       All patients aged 45 to 74 years of age who are not known to have cardiovascular disease.

o       ATSI patients >34 years of age who are not know to have cardiovascular disease.

 

Notes:

o       For ATSI patients, consider the calculated numerical risk to be an estimated minimum cardiovascular risk.

o       For patients with diabetes who are up to 60 years of age, consider the calculated numerical risk to be an estimated minimum cardiovascular risk.

o       The predictive risk for overweight/obese patients has not been considered.

 

 


Interpreting the Results

o       Low risk: Less than 10% probability of cardiovascular disease within the next 5 years.

o       Moderate risk: 10–15% risk of cardiovascular disease within the next 5 years.

o       High risk: Greater than 15% risk of cardiovascular disease within the next 5 years.

 

 


Review Recommendations

Periodic review of absolute cardiovascular risk is recommended dependant on the assessed risk level:

o       Low – review every 2 years

o       Moderate – review every 6–12 months

o       High – review according to clinical context.

 

To remind you and your patient of a scheduled review, consider creating a Recall notification.

 

 


Using the Cardiovascular Risk Calculator

1.      From within the Clinical Window, select Tools > Tool Box > Cardiovascular Risk. The CV Risk tab appears. Select which calculator you wish to use. If you select the Absolute calculator, the following fields will be pre-populated with data, where available:

o       Gender. As sourced from the patient's record.

o       Age. As sourced from the patient's record.

o       Systolic blood pressure. As sourced from the most recent blood pressure 'sitting' data, recorded within the last 2 months.

o       Diastolic blood pressure. As sourced from the most recent blood pressure 'sitting' data, recorded within the last 2 months.

o       Smoking status. A patient who has quit smoking within the last year will be considered a smoker for the purposes of the calculator.

o       Total Cholesterol. As sourced from the most recent Total Cholesterol data, recorded within the last 2 months.

o       HDL Cholesterol. As sourced from the most recent HDL Cholesterol data, recorded within the last 2 months.

o       Diabetes. As sourced from the patients past medical history, see Absolute CVD Risk Diagnosis Descriptions.

 

2.      Options:

o       For patients who are automatically considered 'high risk',  simply click to automatically document the risk value as >15% in the Tool Box. This will also add a note to the patient's Progress Notes. There are no further actions required. You may exit the Tool Box.

o       For all other patients, click  Proceed now to Step 3.

 

3.      Enter values for the following fields:

o       Systolic Blood Pressure  - (Enter a value between 50 and 300).

o       Diastolic Blood Pressure - (Enter a value between 20 and 150).

o       Total Cholesterol - (Enter a value between 2 and 30).

o       HDL Cholesterol - (Enter a value between 0.2 and 20).

 

4.      Indicate the patient's smoking and diabetes status, and ECG LVH. Note that this is not the same as 'echo LVH' which is a lesser risk factor.

5.      Click  A new entry appears within the recorded data on the right-hand side of this window. Note that this data is saved to this window for future reference, and a record is made in the patient's Progress Notes.

Results > 15% are not displayed in the table of results, as such values are superfluous.

 

 

 


Further Considerations

o       Consider creating a Recall notification for your patient for an Absolute CVD Risk review.

o       Ensure you have configured Clinical to notify you of eligible patients via the Preventive Health Prompts options.

 

 


Items of Interest on the CV Risk tab

Switches to the Relative Calculator.

Display the patient's record as a list of data.

Display the patient's record as a graph.

Clears any data you enter into the Current Measurements section of the window.

Creates a 'Cardiovascular Risk Review'  recall notification for this patient.

Prints the patient's CV risk data.  If you have filtered the data, this will be reflected in the printout.

Calls a window containing reference information.

Not applicable to CV risk.

Not applicable to CV risk.

Save values to this window.

 

 


References

o       National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascular disease risk. 2009. www.nhmrc.gov.au/publications

o       Anderson KM, Odell PM, Wilson PW, and Kannel WB. Cardiovascular disease risk profiles. American Heart Journal 1999;121;293-298.

 

 


NVDPA Summary of Practice Points

a

In adults without known cardiovascular disease, a comprehensive assessment of cardiovascular risk includes consideration of the following:

Modifiable risk factors

  • smoking status

  • blood pressure

  • serum lipids

  • waist circumference and body mass index

  • nutrition

  • physical activity level

  • alcohol intake*

 

Non-modifiable risk factors

  • age and sex

  • family history of premature cardiovascular disease

  • social history including cultural identity, ethnicity, socioeconomic status and mental health

 

Related conditions

  • diabetes

  • renal function (microalbumin ± urine protein, estimate of glomerular filtration rate)

  • familial hypercholesterolaemia

  • evidence of atrial fibrillation (history, examination, electrocardiogram)

b

For adults at high risk of cardiovascular disease, identifying all cardiovascular risk factors present enables investigation and intensive management by lifestyle interventions (all patients) and pharmacological interventions (where indicated).

c

A comprehensive assessment of cardiovascular risk involves consideration of socioeconomic deprivation, because it is an independent risk factor for cardiovascular disease. Absolute risk of cardiovascular disease calculated using the Framingham Risk Equation is likely to underestimate cardiovascular risk in socioeconomically deprived groups.†

d

In adults with atrial fibrillation (particularly those aged over 65 years), the increased risk† of cardiovascular events and all-cause mortality, in addition to thromboembolic disease and stroke, should be taken into account when assessing absolute cardiovascular risk.

e

The following qualitative risk categories can be used to describe calculated absolute cardiovascular risk:

  • “Low” risk corresponds to less than 10% probability of cardiovascular disease within the next 5 years

  • “Moderate” risk corresponds to 10–15% risk of cardiovascular disease within the next 5 years

  • “High” risk corresponds to greater than 15% risk of cardiovascular disease within the next 5 years.

 

f

Regular review of absolute cardiovascular risk is recommended at intervals according to initial assessed risk level:

  • Low – review every 2 years

  • Moderate – review every 6–12 months

  • High – review according to clinical context.

 

Ұ These practice points were developed to facilitate clinical uptake of these guidelines by GPs and other target users.

* Alcohol is a risk factor for elevated blood pressure (which is itself a major independent determinant of risk of atherosclerotic disease), stroke and cardiomyopathy. For a full discussion of this, please refer to the draft 2007 NHMRC Alcohol Guidelines (Public Consultation document).

† While CVD risk is known to be elevated for this population, it is not possible to quantify the degree of additional CVD risk in an individual. Clinical judgement is necessary when assessing an individual’s overall CVD risk.

 

 


NVDPA Disclaimer

This Australian Absolute cardiovascular disease risk calculator has been produced by the National Vascular Disease Prevention Alliance for the information of health professionals. The statements and recommendations it contains are, unless labelled as ‘expert opinion’, based on independent review of the available evidence. Interpretation of the results of this calculator by those without appropriate medical and/or clinical training is not recommended, other than at the request of, or in consultation with, a relevant health professional.

While care has been taken in preparing the content of this material, the National Vascular Disease Prevention Alliance and their employees cannot accept any liability, including for any loss or damage, resulting from the reliance on the content, or for its accuracy, currency and completeness. This material may be found in third parties’ programs or materials. This does not imply an endorsement or recommendation by the National Vascular Disease Prevention Alliance for such third parties’ organisations, products or services, including these parties’ materials or information. Any use of National Vascular Disease Prevention Alliance material by another person or organisation is done so at the user’s own risk. The entire contents of this material are subject to copyright protection.