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The Dundee coronary risk-disk for management of change in risk factors
1Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee.
Insights
A new simplified system, the Dundee coronary risk-disk, effectively assesses modifiable coronary risk using smoking, blood pressure, and cholesterol. This tool aids primary care in prioritizing high-risk patients for intervention.
Area of Science:
- Cardiology
- Preventive Medicine
- Primary Care
Background:
- Coronary heart disease remains a leading cause of mortality.
- Effective risk stratification is crucial for preventive strategies.
- Current methods for assessing modifiable coronary risk in primary care can be complex.
Purpose of the Study:
- To develop and evaluate a simplified system for grading and monitoring modifiable coronary risk in primary care settings.
- To create an associated action plan to guide clinical interventions.
- To improve the efficiency and effectiveness of coronary risk management.
Main Methods:
- A risk equation was derived from the United Kingdom heart disease prevention project.
- Population rank was established using data from the Scottish heart health study.
- The Dundee coronary risk-disk was developed, incorporating the risk formula and tested against the Whitehall study.
- The disk and action plan were evaluated in primary care.
Main Results:
- The system provides a sex- and age-related rank (1-100) based on smoking, blood pressure, and cholesterol.
- The formula demonstrated acceptable prediction in the Whitehall study.
- Most surveyed general practitioners and practice nurses (89%) expressed interest in using a risk score system.
- The Dundee coronary risk-disk and action plan were proposed for routine incorporation.
Conclusions:
- The Dundee coronary risk-disk offers a simple, valid method for assessing and monitoring modifiable coronary risk.
- The system effectively contextualizes individual risk factors and supports selective testing.
- Improved understanding by medical staff and patients is expected to enhance coronary prevention efforts.
Objective:
To devise a simplified system for grading and monitoring modifiable coronary risk in primary care, to be used with an action plan.
Methods:
The risk equation came from 5203 men aged 40-59 in the United Kingdom heart disease prevention project, who had 331 coronary events over five years; the population rank (reading 1-100) was obtained by scoring 10,359 participants in the Scottish heart health study. Calculation of rank was embodied in the Dundee coronary risk-disk; the formula was tested against the Whitehall study; disk and action plan were evaluated in primary care.
Results:
The system measures modifiable coronary risk from smoking, blood pressure, and blood cholesterol concentration by a sex and age related rank running from 1 (high risk, priority action) to 100 (low risk, general advice). The formula predicted outcome acceptably in the Whitehall study and is built into a circular slide rule. Only eight (11%) of 76 general practitioners and practice nurses surveyed already used risk factor scores. After evaluation most thought they should use one and proposed to incorporate the Dundee coronary risk-disk and the associated action plan into their routines.
Conclusion:
The Dundee coronary risk-disk readout of Dundee rank, standardised on a scale of 1 to 100 by age and sex, is a simple, valid means of assessing and monitoring modifiable coronary risk. It puts single risk factors (such as cholesterol concentration) in perspective and can aid selective testing. Understood by medical staff and patients, it should improve the efficiency and effectiveness of the high risk approach to coronary prevention.