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Cardiovascular Risk Assessment for Comprehensive Healthcare Solutions

Piyanun Yenjit, Founder, Apuk Co., Ltd

Cardiovascular disease looms as a prominent global health concern. Successfully tackling this challenge depends on skilled risk management. Tailoring screening methods to local population traits and the competence of those conducting screenings are crucial. Integrating and simplifying multiple screening tools can enhance effectiveness and minimize variations among screeners.

Cardiovascular disease represents a major issue in public health, affecting both immediate and long-term health outcomes. Early detection and management of risk factors is crucial for effective intervention.

Multiple cardiovascular risk assessment tools are available, each designed to use specific information like medical conditions, family health history, and laboratory test results. However, it's important to recognize that each tool has its limitations. Therefore, how effectively these tools are used in real-world scenarios depends greatly on the skill and knowledge of the person conducting the evaluation, as well as the specific circumstances in which the assessment is being made.

To make cardiovascular risk assessment more accessible and user-friendly, combining various screening tools into a unified system with a coherent logic for their collective use is beneficial. This integrated approach removes the necessity of choosing a specific tool, as the system would automatically evaluate risk factors based on the inputted information and select the most appropriate and detailed results for the user. Such a system can be utilized across various settings, from community screenings by individuals with basic medical training and without lab results to in-depth assessments in medical facilities by doctors and nurses with access to comprehensive lab data. This inclusive strategy aims to enhance the availability and effectiveness of cardiovascular risk assessments for the wider public in diverse healthcare environments.

This article will demonstrate a methodology to integrate and simplify five prominent cardiovascular risk assessment tools. The process will involve streamlining these tools into a singular, user-friendly framework that can be easily employed in various healthcare settings.

1. The Framingham Risk Score (FRS) is a tool used in medicine to estimate an individual's risk of developing cardiovascular disease within a specific period, usually over the next 10 years. This risk assessment model was developed based on data from the Framingham Heart Study, a long-term cardiovascular cohort study that began in Framingham, Massachusetts in 1948. The Framingham Risk Score considers several risk factors, which typically include age, gender, and smoking status, history of hypertension, blood pressure, and lipid profile. However, FRS may not be fully accurate for all populations, as it was developed based on a specific cohort.

2. The ASCVD Risk Estimator tool is a clinical tool used by healthcare providers to estimate a patient's 10-year and lifetime risk of developing atherosclerotic cardiovascular disease (ASCVD). This tool is based on guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA). The primary purpose of the ASCVD Risk Estimator is to assist clinicians in identifying individuals at higher risk of ASCVD so that preventative measures can be discussed and implemented.

3. QRISK is a clinical algorithm used in the United Kingdom to assess the risk of developing cardiovascular disease (CVD) over the next 10 years. It was developed to provide a more accurate and tailored assessment for the UK population, considering specific factors that may influence CVD risk in this group. The strength of QRISK is its consideration of different ethnic groups, which can have varying risks of CVD. This tool also includes a broader range of medical conditions in its assessment compared to some other risk calculators, such as atrial fibrillation, chronic kidney disease, and conditions like systemic lupus erythematosus.

4. The Reynolds Risk Score is a risk assessment tool designed to predict the 10-year risk of developing major cardiovascular events, such as heart attack, stroke, or cardiovascular-related death. It was developed as an enhancement to traditional risk assessment tools like the Framingham Risk Score by including additional risk factors. Unlike the traditional risk scores, the Reynolds Risk Score includes measurements of C-reactive protein (CRP) and family history of heart disease.

5. The WHO/ISH (World Health Organization/International Society of Hypertension) risk prediction charts are a cardiovascular risk assessment tool developed to estimate an individual's risk of developing cardiovascular disease (CVD) over the next 10 years. This tool is particularly useful in primary care settings, especially in low and middle-income countries where resources for detailed risk assessments might be limited. Compared to other tools, these charts are designed for use in different geographic regions, with specific versions tailored to different parts of the world and simple to use, requiring only basic clinical measurements like blood pressure, age, gender, smoking status, and presence or absence of diabetes.

The primary challenge users often face is determining which risk assessment tool to use and managing situations with limited resources, such as when blood pressure levels, medication details, and laboratory results are unknown. Although each cardiovascular risk assessment tool requires different data for its calculations, there are common data domains that most of these tools consider essential. These include age, gender, smoking status, blood pressure, and total cholesterol level as Table 1.

The input elements will be divided into seven categories: demographic data, health risk, underlying disease, medication, family history, basic measurement, and laboratory. To proceed with the implementation of the form, either in an offline or online format, it is necessary to establish which fields are mandatory and to set default values for them, sample as Table 2.

In online settings, it is necessary to have the calculation logic either embedded in the form or connected to external microservices. However, this article does not provide specific details regarding this type of logic.

After conducting tests using the scenario of a 48-year-old male with underlying hypertension and dyslipidemia in various settings as described below. The result eliminates the need for the user to select the tools as Table 3.

1. Self-assessment: The general population can perform this on their own. If blood pressure measurement is not available, the options for blood pressure values are either unknown or normal.
2. Basic assessment: The assessment conducted by non-healthcare professionals, blood pressure measurement is available and able to identify which medication is statin group.
3. Advanced: The assessment conducted by healthcare professionals with available laboratory results; lipid profile and hsCRP is optional.

The final outcome presents a range of risk values, from minimum to maximum, which varies between each setting and the available inputs.

Cardiovascular disease is becoming an increasingly significant concern. Despite advancements in treatment technology, prevention and early risk management remain the most effective methods for addressing this issue. Various risk assessment tools are available, but each has its limitations. Furthermore, these tools require different types of input, some of which can be quite complex. The accuracy of these tools also depends on the user's competence and the appropriateness of the tool selection.

This article presents a methodology for integrating the top five cardiovascular risk assessment tools to enhance user convenience. This integration caters to a wide range of settings, from basic self-assessments with limited clinical data to comprehensive evaluations conducted by healthcare professionals with access to detailed clinical information. The steps for this integration are outlined below:

1. Choose the suitable Tool
2. Compile inputs required by each tool
3. Group similar inputs together
4. Establish standard codes, default values, and mandatory status for each input
5. Link to relevant microservices logic to calculate the risk

This form is designed to be applicable to every user and patient in all settings. While the results may not be perfect, owing to the variability of available data and other unknown factors, it will undoubtedly enhance the accessibility of risk assessment and reduce discrepancies across different users and settings.

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Author Bio

Piyanun Yenjit

Piyanun Yenjit is a country manager of HIMSS Thailand and founder of APUK, a healthcare digital transformation consultant and micro services provider, focusing on improvement in patient safety, process efficiency, and business growth. She is also experienced in electronic medical records with structured data implementation compatible with various quality assurance standards.

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