Cardiovascular disease risk assessment in an Aboriginal community-controlled health service: comparing algorithms

2020 ◽  
Vol 26 (4) ◽  
pp. 281 ◽  
Author(s):  
Xavier Fitzgerald ◽  
Ana Herceg ◽  
Kirsty Douglas ◽  
Nadeem Siddiqui
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
High Risk ◽  
Health Service ◽  
Torres Strait Islander ◽  
Lipid Lowering ◽  
Risk Scores ◽  
Cvd Risk ◽  
Aboriginal Community ◽  
Torres Strait

Aboriginal and Torres Strait Islander people have high rates of cardiovascular disease (CVD). The National Vascular Disease Prevention Alliance (NVDPA) CVD risk assessment algorithm is used for all Australians. The Central Australian Rural Practitioners Association (CARPA) algorithm used in the Northern Territory adds five percentage points to all NVDPA risk scores for Indigenous Australians. Information was extracted from an Aboriginal Community-Controlled Health Service for all Aboriginal and Torres Strait Islander regular clients aged 35–74 years without known CVD (n=1057). CVD risk scores were calculated using both algorithms. Prescription of lipid-lowering medications was assessed. Clients with high-risk scores were reviewed and recalled if required. CVD risk scores were calculated for 362 (34.4%) clients. Clients with high CVD risk comprised 17.7% (NVDPA) or 23.8% (CARPA), with most determined clinically. Clients with low CVD risk comprised 73.7% (NVDPA) or 47.2% (CARPA). More than 30% of those with high risk were not on lipid-lowering medications. Significant health and social issues affected treatment uptake. It is unclear which algorithm is most applicable; however, this service has decided to continue to use the NVDPA algorithm. Use of CVD risk assessment and management of high-risk clients could be increased in primary care.

scholarly journals 961Absolute cardiovascular disease risk scores and medication use in rural India

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Mulugeta Molla Birhanu ◽  
Roger G Evans ◽  
Ayse Zengin ◽  
Michaela A Riddell ◽  
Kartik Kalyanram ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Absolute Risk ◽  
Risk Groups ◽  
Assessment Tools ◽  
Lipid Lowering ◽  
Risk Scores ◽  
High Risk Population ◽  
Cvd Risk ◽  
Risk Scoring

Abstract Background Low-to-middle-income countries (LMICs) have limited resources to tackle the burden of cardiovascular disease (CVD). Most screening guidelines recommend the use of absolute risk scoring to determine treatment, but there is uncertainty among policy makers and clinicians about which risk algorithm to choose. We aimed to compare laboratory-based absolute CVD risk algorithms in a LMIC setting. Methods The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute risk was computed and compared using the Framingham, WHO, and Australian absolute risk CVD algorithms. Results In participants aged 35-74 years, 151 (3%) had prior CVD. In all algorithms, absolute CVD risk increased with age and was greater in men than women. Using the WHO algorithm 4% were characterized as high-risk while >29% were at high-risk using the Australian risk tool. Agreement of risk classification among men ranged from a high of 84% (Spearman’s rho (rs) =0.92) between Australian and Framingham algorithms to 43% (rs=0.6) between the Australian and WHO risk scores. Among the high-risk population, only 15% were on lipid-lowering or antihypertensive therapy. Conclusions The Framingham and Australian risk scores enable some discrimination between high- and low-risk groups. However, the WHO algorithm underestimates these high-risk groups. Even though one third of the participants were at high-risk, most of them were not receiving recommended treatment. Key messages Lab-based CVD risk assessment tools have the potential in identifying high-risk populations in LMICs but the WHO risk scoring tool should be used with caution.

scholarly journals Cardiovascular risk assessment: Audit findings from a nurse clinic – a quality improvement initiative

2009 ◽  
Vol 1 (3) ◽  
pp. 226
Author(s):  
Sarah Waldron ◽  
Margaret Horsburgh
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Community Support ◽  
Lipid Lowering ◽  
Quality Improvement Initiative ◽  
Cvd Risk ◽  
Retrospective Audit ◽  
Prescribing Trends

BACKGROUND AND CONTEXT: Evidence has shown the effectiveness of risk factor management in reducing mortality and morbidity from cardiovascular disease (CVD). An audit of a nurse CVD risk assessment programme undertaken between November 2005 and December 2008 in a Northland general practice. METHOD : A retrospective audit of CVD risk assessment with data for the first entry of 621 patients collected exclusively from PREDICT-CVDTM, along with subsequent data collected from 320 of these patients who had a subsequent assessment recorded at an interval ranging from six months to three years (18 month average). RESULTS: Of the eligible population (71%) with an initial CVD risk assessment, 430 (69.2%) had a five year absolute risk less than 15%, with 84 (13.5%) having a risk greater than 15% and having not had a cardiovascular event. Of the patients with a follow-up CVD risk assessment, 34 showed improvement. Medication prescribing for patients with absolute CVD risk greater than 15% increased from 71% to 86% for anti-platelet medication and for lipid lowering medication from 65% to 72% in the audit period. STRATEGIES FOR IMPROVEMENT: The recently available ‘heart health’ trajectory tool will help patients become more aware of risks that are modifiable, together with community support to engage more patients in the nurse CVD prevention programme. Further medication audits to monitor prescribing trends. LESSONS: Patients who showed an improvement in CVD risk had an improvement in one or more modifiable risk factors and became actively involved in making changes to their health. KEYWORDS: Cardiovascular disease risk assessment; nurse clinics; audit

Proportion of patients eligible for statin therapy substantially varies between different cardiovascular disease risk calculators and guidelines used

2021 ◽  
pp. 095646242110293
Author(s):  
Matthias C Mueller ◽  
Susanne Usadel ◽  
Winfried V Kern ◽  
Andreas Zirlik ◽  
Qian Zhou
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Statin Therapy ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Hiv Care ◽  
Risk Scores ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Cross Sectional

Because people living with HIV (PLWH) have an elevated risk for cardiovascular disease (CVD), prevention of CVD should be integrated in to HIV care. In this study, we compared the agreement between three risk scores and evaluated the indication for statin therapy based on guidelines of the American Heart Association and European AIDS Clinical Society. This study is a cross-sectional, single-center study. All PLWH ≥ 30 years without CVD and statin therapy were consecutively enrolled. Agreement between CVD risk estimates was assessed using Cohen’s kappa coefficient. Of 488 PLWH, 41.2% were female with a median age of 47.8 years. D:A:D-R classified the highest proportion of patients in the categories of high/very high risk for CVD (17.8%) compared to SCORE (4.7%) and FRS (13.7%). D:A:D-R and SCORE (κ = 0.11) as well as D:A:D-R and FRS (κ = 0.33) showed poor agreement. Based on different CVD risk equations and guidelines, indication for statin therapy ranged from 34.8% to 92.0% of patients. In conclusion, a high proportion of PLWH is at high risk for CVD likely underestimated by treating physicians. Inconsistencies in the evaluation of CVD risk and primary prophylaxis should be tackled by an interdisciplinary approach.

The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy

2005 ◽  
Vol 11 (2) ◽  
pp. 53 ◽  
Author(s):  
Ben Bartlett ◽  
John Boffa
Keyword(s):  
Health Policy ◽  
Health Service ◽  
Health Services ◽  
Torres Strait Islander ◽  
Aboriginal Health ◽  
Aboriginal Community ◽  
Implementation Phase ◽  
Torres Strait ◽  
Strategic Relationships ◽  
The Impact

This paper reviews the advocacy role of Aboriginal community controlled health services (ACCHSs) in the development of Aboriginal health policy over the past 30 years, with a specific focus on the recent changes in Commonwealth funding and administrative responsibility - the transfer of Aboriginal health service funding from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Office of Aboriginal and Torres Strait Islander Health Services (OATSIHS) within the Commonwealth Department of Health and Ageing (DoHA), and the development of policies aimed at Aboriginal health services accessing mainstream (Medical Benefits Scheme [MBS]) funds. The outcomes of this policy change include a significant increase in funding to Aboriginal primary health care (PHC), the inclusion of ACCHSs in collaborative strategic relationships, and the development of new arrangements involving regional planning and access to per capita funds based on MBS equivalents. However, the community sector remains significantly disadvantaged in participating in this collaborative effort, and imposed bureaucratic processes have resulted in serious delays in releasing funds for actual services in communities. Government agencies need to take greater heed of community advocacy, and provide appropriate resourcing to enable community organisations to better direct government effort, especially at the implementation phase. These remain major concerns and should be considered by non-health sectors in the development of new funding and program development mechanisms in the wake of the abolition of ATSIC.

scholarly journals Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement

2020 ◽  
Vol 212 (9) ◽  
pp. 422-427
Author(s):  
Jason W Agostino ◽  
Deborah Wong ◽  
Ellie Paige ◽  
Vicki Wade ◽  
Cia Connell ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Torres Strait Islander ◽  
Consensus Statement ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Torres Strait

scholarly journals The effect of hepatitis C virologic clearance on cardiovascular disease biomarker lipoprotein-associated phospholipase A2 and its relation to serum lipids

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amira Isaac ◽  
Basant Elmarashly ◽  
Kadry El Saeed ◽  
Rasha Samir Mohamed ◽  
Shereen Abdelmonem Ibrahim ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Hepatitis C ◽  
High Risk ◽  
Phospholipase A2 ◽  
Serum Lipids ◽  
Density Lipoprotein ◽  
Cardiac Biomarkers ◽  
Risk Scores ◽  
Cvd Risk ◽  
Chronic Hcv

Abstract Background Chronic hepatitis C virus (HCV) infection has been linked to cardiovascular disease (CVD). However, CVD risk prediction in chronic HCV-infected patients is problematic as the prevalence of different cardiac biomarkers in these patients is currently unknown. Serum lipids, which are routinely used in traditional CVD risk scores, may underestimate CVD risk in these patients, while non-hepatically produced biomarkers, including lipoprotein-associated phospholipase A2 (Lp-PLA2), may better reflect CVD risk. In this study, we aimed to evaluate the effect of sustained virologic response (SVR) on CVD risk, predicted by Lp-PLA2 mass in comparison with serum lipid levels. Results Ninety chronic HCV-infected patients were enrolled in this study. Serum Lp-PLA2 mass was measured before and after HCV treatment via direct-acting antivirals and compared with the changes in serum lipids and Framingham risk score (FRS). The Lp-PLA2 level was categorized into high (>235 ng/ml) or low predicted CVD risk (≤235 ng/ml). Mean Lp-PLA2 mass significantly decreased from 322.37 ± 79.15 ng/ml to 263.79 ± 51.804 ng/ml with SVR, and the number of high-risk patients significantly dropped from 82.22 to 60% after treatment. Total cholesterol, low-density lipoprotein, and high-density lipoprotein levels were low/optimal at baseline (170 ± 40.34 mg/dl, 71.98 ± 24.12 mg/dl, and 48.43 ± 6.79 mg/dl) and significantly increased with SVR (195.66 ± 55.68 mg/dl, 103.24 ± 46.57 mg/dl, and 53.91 ± 8.67 mg/dl). According to FRS, only 30% of patients were moderate/high risk at baseline and insignificantly declined to 28.89% post-treatment. Conclusion Lp-PLA2 may be a better predictor of CVD risk in chronic HCV-infected patients. Furthermore, SVR may reduce hepatic inflammation and consequently CVD risk.

Absolute cardiovascular disease risk and lipid‐lowering therapy among Aboriginal and Torres Strait Islander Australians

2018 ◽  
Vol 209 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Bianca Calabria ◽  
Rosemary J Korda ◽  
Raymond W Lovett ◽  
Peter Fernando ◽  
Tanya Martin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Torres Strait Islander ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Torres Strait
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