Family Medicine Forum Research Proceedings 2014/Compte rendu sur la recherche au Forum en médecine familiale 2014

Context Cardiovascular disease is the most prevalent chronic medical condition in Canada. A strategy of managing cardiovascular disease risk based on routinely performing personalized risk estimates and progressively targeting interventions toward risk factors can reduce morbidity and mortality. One barrier to the widespread adoption of such a risk stratification approach in clinical practice is the lack of an easy-to-use tool that provides risk-based recommendations and encourages shared decision making. Objective To develop a patient-centred, clinical decision support tool for the primary prevention of cardiovascular disease that encourages evidence-based decision making. Design Systematic review. Methods The clinical practice guideline database of the Canadian Medical Association was reviewed for guidelines focused on the primary prevention of cardiovascular disease in adult populations. Review of the guidelines led to a search of PubMed for multivariable risk algorithms (key words: Framingham heart study) and a search of the Cochrane database for meta-analyses of recommended interventions (key words: cardiovascular disease and prevention); if meta-analyses were unavailable, PubMed was searched for randomized controlled trials. Results We created a Web-based application (www.cardiovascularcalculator.radarhill.net) that provides personalized multivariable risk estimates of developing coronary artery disease and stroke over the next 10 years based on age, sex, smoking status, family history of early coronary artery disease, systolic blood pressure, use of antihypertensive medication, and lipid profile. The application also presents personalized, risk-based recommendations for lifestyle modification and pharmaceutical intervention from 5 Canadian guidelines for the prevention of cardiovascular disease, in addition to modified risk estimates for developing cardiovascular disease over the next 10 years for selected interventions (smoking cessation, treatment of blood pressure with various agents and to various targets, treatment with cholesterol-lowering agents, and treatment with antiplatelet medication) and risk estimates of developing treatment-related adverse events. Outcomes are presented both graphically and numerically, as absolute risks with accompanying numbers-needed-to-treat estimates and optional confidence intervals. Conclusion We have developed an interactive, Web-based clinical decision support tool that can conveniently assess coronary heart disease and stroke risk and provide personalized, guideline-based recommendations with evidence-based risk reduction estimates for various lifestyle and pharmaceutical interventions. Research | FMF Research Proceedings 2014