Heart Attack and Stroke Debacle
New 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.
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.