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Comparison of Patients Classified as High-Risk between International Cardiovascular Disease Primary Prevention
Niamh Chapman1,2, Monique Breslin2, Zhen Zhou2,3
1School of Health Science, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia.
Insights
International cardiovascular disease (CVD) prevention guidelines show little agreement on who should receive pharmacological treatment. This highlights a need for greater consistency in high-risk classification to improve CVD primary prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Health Policy
Background:
- Cardiovascular disease (CVD) primary prevention guidelines identify high-risk individuals for pharmacological treatment using clinical criteria and risk estimation.
- International guidelines, though based on similar evidence, present variations in recommendations, potentially affecting treatment eligibility.
- Discrepancies in guideline recommendations can lead to inconsistent patient management for CVD prevention.
Purpose of the Study:
- To assess the agreement in CVD treatment recommendations among guidelines from Australia, England, and the United States.
- To evaluate how different international guidelines classify individuals at high risk for cardiovascular disease.
- To determine the concordance of pharmacological treatment recommendations based on varying national CVD prevention guidelines.
Main Methods:
- A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (n=2647).
- Adults aged 40 years and older were categorized based on high-risk criteria from Australian, English, and US CVD prevention guidelines.
- Agreement in high-risk classification and treatment recommendation was quantified using the Kappa statistic.
Main Results:
- The proportion of participants recommended for treatment varied significantly: US (49.8%), England (48.2%), and Australia (26.6%).
- Moderate agreement was observed between English and US guidelines (κ=0.69).
- Minimal to weak agreement was found between Australian and US (κ=0.47) or Australian and English guidelines (κ=0.50).
Conclusions:
- There is a notable lack of agreement between major international CVD prevention guidelines regarding treatment recommendations.
- The findings underscore the need for enhanced consistency in high-risk classification across CVD prevention guidelines.
- Standardizing risk assessment criteria could lead to more equitable and effective CVD primary prevention strategies globally.
Abstract:
Background: Cardiovascular disease (CVD) primary prevention guidelines classify people at high risk and recommended for pharmacological treatment based on clinical criteria and absolute CVD risk estimation. Despite relying on similar evidence, recommendations vary between international guidelines, which may impact who is recommended to receive treatment for CVD prevention. Objective: To determine the agreement in treatment recommendations according to guidelines from Australia, England and the United States. Methods: Cross-sectional analysis of the National Health and Nutrition Examination Survey (n = 2647). Adults ≥ 40 years were classified as high-risk and recommended for treatment according to Australia, England and United States CVD prevention guidelines. Agreement in high-risk classification and recommendation for treatment was assessed by Kappa statistic. Results: Participants were middle aged, 49% were male and 38% were white. The proportion recommended for treatment was highest using the United States guidelines (n = 1318, 49.8%) followed by the English guidelines (n = 1276, 48.2%). In comparison, only 26.6% (n = 705) of participants were classified as recommended for treatment according to the Australian guidelines. There was moderate agreement in the recommendation for treatment between the English and United States guidelines (κ = 0.69 [0.64-0.74]). In comparison, agreement in recommendation for treatment was minimal between the Australian and United States guidelines (κ = 0.47 [0.43-0.52]) and weak between the Australian and English guidelines (κ = 0.50 [0.45-0.55]). Conclusions: Despite similar evidence underpinning guidelines, there is little agreement between guidelines regarding the people recommended to receive treatment for CVD prevention. These findings suggest greater consistency in high-risk classification between CVD prevention guidelines may be required.
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