Heart Attack and Stroke Debacle

Heart Attack and Stroke Debacle

Screen Shot 2014-02-02 at 12.32.06 AMNew AHA-ACC (American Heart Association and American College of Cardiology) guidelines are causing quite a debacle in health care. In 2013 the AHA-ACC implemented four new guidelines on the management and assessment of cardiovascular risk factors (New York Times, 2014). The goal of the risk assessment guideline/tool is to predict a patients 10 year risk of atherosclerotic cardiovascular disease (ASCVD), heart attack and stroke .

The risk assessment looks at race, sex, high-density lipoprotein (HDL) cholesterol level, total cholesterol level, use of antihypertensives, diabetes, smoking status and systolic blood pressure, looking at the calculated percentage being  ≥ 7.5%who are at risk of ASCVD, heart attack and stroke (Yancy, Harrington, & Robinson, 2014). Evaluating the need of how likely one is to benefit from statin therapy (statin are a class of medications that are used to lower blood cholesterol levels).

The debate is the risk assessment calculator can over estimate a person’s risk assessment from 75% – 100%.

According to the risk assessment guidelines patients who are 20-79 years of age who do not have clinical ASCVD  and who’s 10 year risk percentage is less then 7.5%, those individuals risk factors should be assessed every four to six years (Rosenburg, 2014). Therefore recommending statin therapy for a broader group of patients that may not benefit?

The ACC/AHA they make a good “Switzerland” “neutral” statement. In a separate comment ACC/AHA joint statement went something along the lines of these guidelines are not meant to replace sound judgement. These guidelines are to encourage the discussion between a patient and their health care provider about the best methods prevention of a stroke or heart attack based on the patients personal preferences and health history (Stone, Robinson, Lichtenstein, & Bairey Merz, 2013).

If there is such a risk of over estimate where the guidelines can recommend statin therapy to a broader group that may not be beneficial, is this a useful tool? What do you think? Please leave your feedback in the comment section. If you enjoyed this posting please subscribe. Thank you.

I will  conclude by adding a link to the American Heat Association guidelines for additional information  2013 CV Risk Calculator and I will include a link to the American Heart Association clinical vignettes, so you can use to practice using the tool.

References:

Kolata, G. (2013, November 17). The New York Times. Retrieved February 1, 2014, from Risk Calculator for Cholesterol Appears Flawed: http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?pagewanted=1&_r=2&

New York Times. (November, 19 2013). Cardio Source. Retrieved February 1, 2014, from New Risk Assessment and Cholesterol Guidelines Spark Debate: http://www.cardiosource.org/News-Media/Publications/Cardiology-Magazine /2013/11/New-Risk-Assessment-and-Cholesterol-Guidelines-Spark-Debate.aspx

O’Riordan, M. (2013, November 13). How Good Is the New ACC/AHA Risk Calculator? Retrieved February 1, 2014, from Medscape: http://www.medscape.com/viewarticle/814579

Rosenburg, K. (2014). New AHA-ACC Guidelines Could Lead to Major Changes in Clinical Practice. American Journal of Nursing, 13.

Stone, N. G., Robinson, J., Lichtenstein, A. H., & Bairey Merz, N. C. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation Journal of the American Heart Association, 23,24.

Yancy, C. W., Harrington, R. A., & Robinson, J. G. (2014, January 29). American Heart Association (AHA) 2013 Scientific Sessions. New Cholesterol Guidelines and CV Risk Calculator: Controversy Clarified. Dallas, TX: Medscape.

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One thought on “Heart Attack and Stroke Debacle

  1. Pingback: The Great Shake Out Part 1 | The Working Nurse

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