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Global cardiovascular risk evaluation: pattern of algorithm use and risk modification in ‘real life’

Filippi, Alessandro; Giampaoli, Simona; Lapi, Francesco; Mazzaglia, Giampiero; Palmieri, Luigi; Pecchioli, Serena; Brignoli, Ovidio; Cricelli, Claudio; Simonetti, Monica; Sessa, Emiliano; Marchioli, Roberto

Journal of Cardiovascular Medicine: August 2016 - Volume 17 - Issue 8 - p 581–586
doi: 10.2459/JCM.0000000000000124
Original articles: Prevention
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Aims Although calculation of the global cardiovascular risk is strongly recommended, limited data are available regarding the use and the utility of this tool in clinical practice. We aimed at answering the following questions in the setting of Italian general practice: how many patients are evaluated via the cardiovascular risk algorithm; what are their characteristics; and what happens after their evaluation.

Methods We used the Health Search/CSD Longitudinal Patient Database. The software used by about 800 participating GPs allows the calculation of the global cardiovascular risk in automatic. The following data were yearly extracted from the database within 2004–2008: age, sex, and recorded diagnosis of the main cardiovascular and other information encompassing smoking habits, blood pressure, total cholesterol, high density lipoprotein cholesterol (i.e., variables used to calculate cardiovascular risk), BMI, physical activity, triglycerides, glucose and creatinine; wherever available, current cardiovascular therapy and the automatically computed global cardiovascular risk were also extracted.

Results In 2008, the observed population, aged 35–69 years, numbered 438 922 individuals; 78 617 (17.9%) had at least one calculation of cardiovascular risk; 20 181 patients were re-evaluated at least once: 61.1% among high-risk patients, 43.8% among moderate-risk patients, and 27.2% among low-risk patients. The level of cardiovascular risk measured at baseline increased in 6863 (34%), decreased in 11 791 (58.4%), and did not change in 1527 (7.6%) individuals. Overall, mean cardiovascular risk decreased over 4 years in 2.25% (SD 6.41%; P < 0.01) of patients.

Conclusion The calculation of global cardiovascular risk is underused by GPs, who generally assign a higher priority to high-risk individuals. In addition, the use of this algorithm seems to favor a reduction of risk in moderate-risk and high-risk patients.

aItalian College of General Practitioners, Florence

bNational Institute of Health, Rome

cHealth Search, Italian College of General Practitioners

dRegional Agency for Healthcare Services of Tuscany, Florence

eConsorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy

Correspondence to Emiliano Sessa, Regional Agency for Healthcare Services of Tuscany, Florence, Italy E-mail: sessa.emiliano@simg.it

Received 25 January, 2013

Revised 29 March, 2014

Accepted 3 April, 2014

© 2016 Italian Federation of Cardiology. All rights reserved.