Abstract 3264: Remarkable Differences in calculating the Cardiovascular Risk according the Framingham-, Procam- and ESC Risk-Scores. First Results of the DETECT Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sigmund Silber ◽  
Barbara M Richartz ◽  
Frauke Jarre ◽  
David Pittrow ◽  
Jens Klotsche ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Score ◽  
High Risk Group ◽  
Risk Scores ◽  
Individual Risk ◽  
High Risk Patients ◽  
Number Of Patients ◽  
Risk Patients ◽  
The Individual

The identification of high-risk patients is of utmost importance for an intensive and effective primary prevention program. Currently, three different scores are used to identify high-risk patients: In the USA, the Framingham risk score, in Germany the Procam risk score and in Europe the European Society of Cardiology ESC) recommended ESC risk score. There is, however, little knowledge how these three risk scores compare to each other in the same population. Therefore we calculated the individual risk of 7519 pats with no known cardiovascular disease according to these three scoring systems. In the DETECT study, 55 518 patients in 3188 primary care offices were enrolled. A representative subgroup of 7,519 randomly chosen patients participated in a cohort sub-study. According to the Framingham-Procam- and ESC-Score, the individual 10-year-risk was determined and patients were _ategorized into groups of high, medium or low risk. The mean 10-year cardiovascular risk is estimated by the PROCAM score at 4.4%, with the ESC score at 8.8% and with the Framingham-Score at 11.5%. The number of patients assigned to a group differs most for the high risk group (please see table ). Unexpectedly, major discrepancies were observed in the same pats, if the Framingham, Procam- or ESC score was used, especially in the identification of high-risk pats. Follow-up will show, which of these risk scores will best predict the actual occurrence of cardiovascular events. Results:

Cardiovascular risk assessment in diabetes and pre-diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 923-924
Author(s):  
Nikolaus Marx
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Target Organ Damage ◽  
Risk Scores ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Patients with diabetes exhibit an increased propensity to develop cardiovascular disease with an increased mortality. Early risk assessment, especially for coronary artery disease, is important to initiate therapeutic strategies to reduce cardiovascular risk. This chapter reviews the current literature on risk scores in patients with type 1 and type 2 diabetes and summarizes the role of risk assessment based on biomarkers and different imaging strategies. Current guidelines recommend that patients with diabetes are characterized as high-risk or very high-risk patients. In the presence of target organ damage or other risk factors such as smoking, marked hypercholesterolaemia, or hypertension, patients with diabetes are classified as very high-risk patients while most other people with diabetes are categorized as high-risk patients.

scholarly journals SPECIFICS OF ANTIHYPERTENSION THERAPY IN HYPERTENSIVES OF VARIOUS CARDIOVASCULAR RISK (BY THE REGISTRY OF CHRONIC NON-COMMUNICABLE DISEASES IN TYUMENSKAYA OBLAST)

2018 ◽  
Vol 17 (3) ◽  
pp. 4-10
Author(s):  
A. Yu. Efanov ◽  
Yu. A. Vyalkina ◽  
Yu. A. Petrova ◽  
Z. M. Safiullina ◽  
O. V. Abaturova ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Risk Level ◽  
Moderate Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Aim. To assess the specifics of antihypertension therapy (AHT) in hypertensives of various cardiovascular risk, in the registry of chronic non-communicable diseases in Tyumenskaya oblast.Material and methods. A random sample studied, of 1704 patients with hypertension, inhabitants of Tyumenskaya oblast (region), ascribed to dispensary follow-up. Mean age 62±7,5 y.o. Of those 31,5% (n=537) males. The prevalence and efficacy of AHT assessed according to cardiovascular risk level. The significance was evaluated with the criteria χ2.Results. AHT was characterized by the growth of the frequency of treatment approaches with cardiovascular risk consideration. Regular treatment took 33,9% patients of low and moderate risk vs 41,3% of high and very high (p<0,01). In the male group such tendency also took place. Gender specifics of AHT was characterized by that in the groups of high and very high risk females took medications significantly more commonly than males — 46,6% vs 29,1% in high risk group (p<0,01) and 47,5% vs 30% in very high risk group (p<0,01). With the increase of the risk level, there was decline of treatment efficacy — from 95% in low risk group to 32,5% in very high risk group; 53,1% of the participants were taking monotherapy, 32,9% — two drugs, 14,0% — ≥3 drugs. With the increase of risk grade there is tendency to increase of combinational AHT, however with no significant increase of efficacy. Treatment efficacy in high and very high risk patients comparing to patients with low and moderate risk was significantly lower — 33,1% vs 69,7% (p<0,01), respectively. Statins intake among the high and very high risk patients was 10,6-11,0% males and 7,8% females (p<0,05).Conclusion. AHT in hypertensives in Tymenskaya oblast, under dispensary follow-up, is characterized by insufficient usage of combinational drugs. With the raise of cardiovascular risk there is tendency to higher rate of combinational AHT. However there is no significant increase in efficacy of treatment with the increase of medications number. A very low rate of statins intake is noted. The obtained specifics witness for the necessity to optimize AHT among the high and very high risk patients — inhabitants of Tyumenskya oblast.

scholarly journals Diabetic foot and its serial treatment in high-risk patients: focusing on the individual

2020 ◽  
Vol 66 (11) ◽  
pp. 1542-1547
Author(s):  
Eli Ávila Souza Júnior ◽  
Raul Silva Simões de Camargo ◽  
Tiago Soares Baumfeld ◽  
Daniel Soares Baumfeld ◽  
Benjamin Dutra Macedo
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
High Risk Group ◽  
Foot Care ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Individual

SUMMARY Objectives: To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS: This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS: It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS: Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.

Abstract 15961: Multicenter Prospective Prevention of Sudden Death in High Risk Patients Utilizing Enhanced ACC/AHA Risk Model

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ethan J Rowin ◽  
Martin S Maron ◽  
Arnon Adler ◽  
Alfred Albano ◽  
Armanda Varnava ◽  
...  
Keyword(s):  
Risk Factor ◽  
Primary Prevention ◽  
High Risk ◽  
Sudden Death ◽  
Risk Score ◽  
Risk Model ◽  
Risk Scores ◽  
Implantable Cardioverter Defibrillators ◽  
High Risk Patients ◽  
Risk Patients

Introduction: Strategies for reliable selection of high-risk hypertrophic cardiomyopathy (HCM) patients for prevention of sudden cardiac death (SCD) with implantable cardioverter-defibrillators (ICDs) continue to be debated. Objective: Assess the sensitivity of sudden death risk strategies in predicting SCD events (appropriate ICD shocks, sudden death or out of hospital cardiac arrest) among a large multicenter cohort of high-risk HCM patients. Methods: Observational longitudinal study from 6-HCM centers in North America and Europe to determine outcomes in consecutive HCM patients considered high risk for sudden death based on an enhanced ACC/AHA (U.S./Canada) guidelines-based risk factor algorithm with primary prevention ICD placement. ESC risk score was retrospectively calculated in this cohort and compared to ACC/AHA risk factor method for predicting SCD events. Results: Of 1185 patients with primary prevention ICDs implanted based on ≥ 1 major risk marker, 162 (14%) experienced device therapy terminating VT/VF episodes at 49 ± 18 years of age and 4.6 ± 4.2 years after device implant. Within the 6 HCM centers, only 28 other patients not implanted with ICD died suddenly or had resuscitated cardiac arrests, including 19 (68%) with risk-markers who declined ICDs. Of these 190 high risk patients with SCD or SCD events, 67 (35%) had ESC risk-scores scores ≥6%/5-years, considered sufficient to recommend a prophylactic ICD, while 83 (44%) had low risk scores (<4%/5-years) that likely would have excluded an ICD recommendation. Compared to enhanced ACC/AHA risk factors, the ESC risk-score was less sensitive than ACC/AHA (35% vs. 95%, p<0.01), consistent with identifying fewer high-risk patients with events. Conclusion: In this large multicenter study of high-risk HCM patients, an enhanced ACC/AHA risk factor strategy was superior to the ESC risk score in identifying patients at greatest risk for SCD events.

Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3204 high-risk patients

2008 ◽  
Vol 15 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Ana Sánchez-Taínta ◽  
Ramón Estruch ◽  
Mónica Bulló ◽  
Dolores Corella ◽  
Enrique Gómez-Gracia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
Primary Care Physicians ◽  
Individual Risk ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Beneficial Effects ◽  
Risk Patients

Background The Mediterranean food pattern (MeDiet) has been suggested to have beneficial effects on cardiovascular risk factors. Scarcity of assessment of this effect on large samples of patients at high risk is, however, observed. Our objective was to estimate the association between adherence to MeDiet and the prevalence of risk factors in 3204 asymptomatic high-risk patients. Design Cross-sectional assessment of baseline characteristics of participants in a primary prevention trial. Methods Participants were assessed by their usual primary-care physicians to ascertain the prevalence of diet-related cardiovascular risk factors (diabetes, hypertension, dyslipidemia, or obesity) using standard diagnostic criteria. A dietitian interviewed each participant to obtain a 14-point score measuring the degree of adherence to MeDiet. Results Adherence to MeDiet was inversely associated with individual risk factors and, above all, with the clustering of them. The multivariate adjusted odds ratio to present simultaneously the four risk factors for those above the median value of the MeDiet score was 0.67 (95% confidence interval: 0.53–0.85). The multivariate odds ratios for successive categories of adherence to MeDiet were 1 (ref.), 1.03, 0.85, 0.70 and 0.54 ( P for trend ≤0.001). Conclusion Following a MeDiet was inversely associated with the clustering of hypertension, diabetes, obesity, and hypercholesterolemia among high-risk patients.

Abstract WMP59: Premorbid Blood Pressure Control of Incident Transient Ischaemic Attacks and Strokes; Prevalence and Determinants; Analysis of Individual Patient Data over 10 Years

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Chamila Mettananda ◽  
Lixin Li ◽  
Gary Lau ◽  
Rose Wharton ◽  
Linda Bull ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Blood Pressure Control ◽  
Risk Group ◽  
Pressure Control ◽  
High Risk Group ◽  
High Risk Patients ◽  
Transient Ischaemic Attacks ◽  
Risk Patients

Background: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. Aims and Methods: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. Results: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP. Conclusions: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.

Efficacy of a clinical risk prediction tool to prioritize outreach for high-risk cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13524-e13524
Author(s):  
Megan Croyle ◽  
Nathan Handley ◽  
Michael Li ◽  
Adam F Binder ◽  
Valerie Pracilio Csik
Keyword(s):  
High Risk ◽  
High Risk Group ◽  
Risk Scores ◽  
Control Group ◽  
Case Group ◽  
Control Groups ◽  
High Risk Patients ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

e13524 Background: Acute care utilization (ACU), including emergency department visits and hospitalizations, is common in patients with cancer. Prospectively identifying patients’ risk status may enable interventions to reduce ACU. We developed a REDUCE score (Reducing ED Utilization in the Cancer Experience for active oncology patients (defined as patients with an active cancer diagnosis in the last 12 months who had a Medical Oncology encounter in a 180-day period) to prospectively determine risk of ACU. The intended intervention was outreach to all high-risk patients. We evaluated the high risk group over an 11-month period (February through December 2020) to better characterize those who received outreach. Methods: Analysis of high-risk patients was conducted using a case-control method over two periods: February through June 2020 (Period 1) and July through December 2020 (Period 2) to account for a change in the type of outreach deployed. High risk was defined as REDUCE ≥2. High risk scores were stratified by those with REDUCE =2 and those with REDUCE >2. Control Group 1 consisted of high-risk patients with REDUCE =2 who did not receive outreach, and Control Group 2 included high-risk patients with REDUCE >2 who did not receive outreach. Case Group 1 consisted of high-risk patients with REDUCE =2 who had outreach, and Case Group 2 included patients with REDUCE >2 who had outreach. Average ACU per patient was compared across all groups over both periods. Descriptive statistics were applied. Results: Results are described in table 1. Average ACU per patient was higher in Periods 1 and 2 for both Case Groups, compared to both Control Groups. Over time, there was a trend in decreased ACU in the intervention group with stable to increasing ACU in the control groups. The proportion of patients who received outreach across both periods decreased in Case Group 1, but increased in Case Group 2. Conclusions: These findings suggest that patients who received outreach were at a higher risk of ACU. Further investigation revealed that there was not consistent prioritization of patients with the highest risk scores within the high-risk group for outreach. In addition to the REDUCE , ongoing efforts incorporate clinical judgment of the outreach team in assessing additional clinical risk factors to determine an intervention, which is meaningful. The REDUCE tool may provide value as an initial screening mechanism. Average ACU per patient by study group.[Table: see text]

Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Aleksic ◽  
Luebke ◽  
Brunkwall
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Local Anaesthesia ◽  
High Risk Group ◽  
High Risk Patients ◽  
Hostile Neck ◽  
Risk Patients ◽  
Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

scholarly journals Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1631
Author(s):  
Anna Astarita ◽  
Giulia Mingrone ◽  
Lorenzo Airale ◽  
Fabrizio Vallelonga ◽  
Michele Covella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Assessment ◽  
Multiple Myeloma ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
High Risk Group ◽  
Cardiovascular Risk Assessment

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

Effect of a Real-Time Risk Score on 30-day Readmission Reduction in Singapore

2021 ◽  
Vol 12 (02) ◽  
pp. 372-382
Author(s):  
Christine Xia Wu ◽  
Ernest Suresh ◽  
Francis Wei Loong Phng ◽  
Kai Pik Tai ◽  
Janthorn Pakdeethai ◽  
...  
Keyword(s):  
Machine Learning ◽  
High Risk ◽  
Real Time ◽  
Risk Score ◽  
Patient Specific ◽  
Learning Models ◽  
Medicine Department ◽  
High Risk Patients ◽  
Risk Patients ◽  
Machine Learning Models

Abstract Objective To develop a risk score for the real-time prediction of readmissions for patients using patient specific information captured in electronic medical records (EMR) in Singapore to enable the prospective identification of high-risk patients for enrolment in timely interventions. Methods Machine-learning models were built to estimate the probability of a patient being readmitted within 30 days of discharge. EMR of 25,472 patients discharged from the medicine department at Ng Teng Fong General Hospital between January 2016 and December 2016 were extracted retrospectively for training and internal validation of the models. We developed and implemented a real-time 30-day readmission risk score generation in the EMR system, which enabled the flagging of high-risk patients to care providers in the hospital. Based on the daily high-risk patient list, the various interfaces and flow sheets in the EMR were configured according to the information needs of the various stakeholders such as the inpatient medical, nursing, case management, emergency department, and postdischarge care teams. Results Overall, the machine-learning models achieved good performance with area under the receiver operating characteristic ranging from 0.77 to 0.81. The models were used to proactively identify and attend to patients who are at risk of readmission before an actual readmission occurs. This approach successfully reduced the 30-day readmission rate for patients admitted to the medicine department from 11.7% in 2017 to 10.1% in 2019 (p < 0.01) after risk adjustment. Conclusion Machine-learning models can be deployed in the EMR system to provide real-time forecasts for a more comprehensive outlook in the aspects of decision-making and care provision.

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