心血管风险估计和初级保健中他类药物处方的比较:回顾性队列研究
Adam Merlo1,2, Tania Rubaiyyat1
1Family Medicine, Western University, London, CAN.
Cureus
|November 4, 2025
概括
心血管风险计算器产生不同的结果,可能会改变患者管理. 使用动脉样硬化心血管疾病 (ASCVD) 计算器可能会将患者重新分类到较低风险类别,影响他类药物治疗决策.
科学领域:
- 心脏病学 心脏病学
- 预防医学 预防医学
- 医疗信息学 医疗信息学
背景情况:
- 关于为初级预防处方他类药物进行辩论,特别是对于低至中度心血管疾病 (CVD) 风险患者.
- 目前的心血管疾病风险评估工具有局限性,影响临床决策.
研究的目的:
- 为了比较加拿大临床实践中使用的各种心血管风险计算器的风险估计.
- 通过替代计算器确定被重新分类到不同风险类别的患者比例.
主要方法:
- 50名成人患者 (≥40岁) 的回顾性图表审查,没有先前的心血管疾病或他类药物指示.
- 使用弗拉明翰,美国心血管疾病学会 (ASCVD) 和PEER (患者,经验,证据,研究) 在线计算器重新估计心血管疾病风险.
- 将计算的风险与电子病历中记录的价值进行比较.
主要成果:
- 20%的患者在脂质评估时缺乏记录的心血管疾病风险.
- 在EMR和PEER计算器之间的弗雷明汉风险显著平均差异 (3.44%).
- 46%的患者使用ASCVD计算器与Framingham重新分类为较低风险,可能会改变管理.
结论:
- 根据使用的计算器,心血管风险百分比有很大差异.
- 差异可能导致不同的患者管理策略,包括开始服用他类药物.
- 为了使临床实践的一致性,需要进一步研究和纳入指导方针的点的护理风险工具.
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