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Performance of WHO-Updated Cardiovascular Disease Risk Prediction Charts among Doctors: Findings from a Tertiary Care
Arivarasan Barathi1, Sitanshu Sekhar Kar2, Santhosh Satheesh3
1Assistant Professor, Department of Community Medicine, ESIC Medical College and Hospital, Chennai, Tamil Nadu, India.
Insights
The World Health Organization
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- World Health Organization (WHO) updated cardiovascular disease (CVD) risk prediction charts in 2019 for 21 regions.
- Charts include lab-based and non-lab-based versions to estimate overall CVD risk.
- Non-lab version is designed for low-resource settings.
Purpose of the Study:
- To estimate the 10-year burden of fatal or non-fatal CVD events in a tertiary care hospital in Puducherry.
- To assess the agreement between the lab and non-lab versions of the WHO CVD risk prediction charts.
Main Methods:
- Study included 255 doctors from a tertiary care hospital in Puducherry.
- Both charts utilize age, gender, systolic blood pressure, and smoking status.
- Lab chart additionally uses total cholesterol and diabetes mellitus status; non-lab chart uses body mass index. Agreement assessed using Cohen's Kappa (k).
Main Results:
- The majority of doctors had <5% CVD risk, with none exceeding 20% risk, indicating good health-seeking behavior.
- High concordance of 95.2% (95%CI = 91.7 - 97.4) was observed between the two chart versions.
- Strong agreement was quantified by Cohen's Kappa (k = 0.934).
Conclusions:
- WHO-updated CVD risk prediction charts are practical for application when data are available.
- Strong agreement between non-lab and lab-based charts supports their interchangeable use under specific conditions.
Background:
The cardiovascular disease (CVD) risk prediction charts, updated by the World Health Organization for 21 regions in 2019. These charts-lab and non-lab versions-estimate a person's overall CVD risk; the non-lab version is intended for low-resource environments.
Objectives:
Using the "non-lab" and "lab" versions of the WHO CVD risk prediction charts, we sought to estimate the burden of ten-year risk of a fatal or non-fatal CVD event in a tertiary care hospital of Puducherry and to assess the agreement between them.
Materials And Methods:
We included 255 doctors working in a tertiary care hospital in Puducherry. Age, gender, systolic blood pressure, and smoking status are all factors used in both charts. Moreover, a lab chart requires a person's total cholesterol and diabetes mellitus status, whereas a non-lab chart requires a person's body mass index. Proportions (95% confidence intervals) were used to portray the population at various CVD risk levels. Using Cohen's Kappa, the degree of agreement between the lab and non-lab charts was assessed (k).
Results:
The majority of the study participants had <5% risk of CVD, and none had a risk of >20% in both the charts, which shows the better health-seeking behaviour of doctors. A good level of agreement was shown by the 95.2% (95%CI = 91.7 - 97.4 ) concordance in the risk categorization between the two charts (k = 0.934).
Conclusion:
When data are available and there is strong agreement between non-lab and lab-based charts, it is practical to apply WHO-updated CVD risk prediction charts.
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