心血管疾病风险计算器之间的协议
G Michael Allan1, Faeze Nouri, Christina Korownyk
1Evidence-Based Medicine, Department of Family Medicine, University of Alberta, Room 1706 College Plaza, 8215-112 St NW, Edmonton, Alberta T6G 2C8, Canada. michael.allan@ualberta.ca
Circulation
|April 12, 2013
概括
心血管疾病风险计算器显示了风险评估的显著变化,影响了患者分类和治疗指南. 选择一个计算器极大地影响风险估计和分配的类别.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 公共卫生 公共卫生
背景情况:
- 临床指南广泛推使用心血管疾病风险计算器.
- 关于不同计算器的风险评估一致性的研究有限.
- 对计算器使用的指导方针建议需要了解它们的比较性能.
研究的目的:
- 评估常用的风险计算器中心血管疾病风险估计的一致性和可变性.
- 为了比较假设患者的风险分类和不同计算器生成的绝对风险估计.
- 评估计算器变异性对临床决策和准则遵守的影响.
主要方法:
- 一个系统的搜索确定了25个心血管疾病风险计算器.
- 根据7个二分化的风险因素,产生了128名独特的假设患者.
- 两位临床医生独立评估每位患者,使用每个选择的计算器,比较风险估计和类别.
主要成果:
- 在风险分类方面观察到显著的变化,计算器将患者分配到平均2.2个类别.
- 计算器对之间的风险类别协议仅为67%.
- 对于同一个患者,最高计算的风险估计平均比最低估计高4.9倍,无论糖尿病状况如何.
结论:
- 心血管疾病风险计算器的选择对风险分类和绝对风险估计都有重大影响.
- 这种变化对临床指导方针有重大影响,这些指导方针根据特定计算器输出推基于特定计算器输出的疗法.
- 需要对计算器的选择进行标准化或明确指导,以确保一致的患者管理.
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