Navigation Links
Simplified heart-risk guideline may miscalculate risk for millions
Date:9/9/2010

A method that is widely used to predict the risk of a major coronary event may over- or underestimate risk for millions of Americans, according to a study directed by a researcher at the San Francisco VA Medical Center and the University of California, San Francisco.

The method in question is the simplified version of the so-called Framingham model, which is used to estimate a patient's 10-year risk of a heart attack, stroke, or other coronary event based on risk factors such as age, cholesterol levels, blood pressure, and smoking. National guidelines recommend using the risk estimates generated by the Framingham model to classify patients as among one of three risk groups. Guidelines recommend more aggressive strategies to treat cholesterol in patients classified into higher-risk groups.

The original Framingham model uses a complicated mathematical equation to calculate risk, while the simplified version is based on a point system, with a certain number of points for each risk factor.

"We thought there might be significant differences between the two methods, which would have significant impacts on how people are treated for cholesterol," says principal investigator Michael Steinman, MD, a physician at SFVAMC and an assistant professor of medicine at UCSF. "And in fact, that turned out to be the case."

For the study, which appears in the Online First section of the "Journal of General Internal Medicine," the researchers assessed data from 2,543 subjects who participated from 2001 to 2006 in National Health and Nutrition Examination Surveys sponsored by the Centers for Disease Control and Prevention. The subjects were chosen to be representative of 39 million adults in the United States for whom guidelines recommend using the Framingham method to predict future cardiovascular risk.

For each subject, the researchers calculated risk based on the original Framingham model and on the simplified model, and compared the differences, "which turned out to be substantial for many patients," says Steinman, who is senior author of the paper.

Under the point-based system, 15 percent of the subjects were classified as being at a different level of risk than they were under the original model. Nationwide, say the authors, 5.7 million Americans would be placed into different risk groups using the point-based model than they would be using the original model, with 3.9 million misclassified into higher risk groups and 1.8 million misclassified into lower risk groups.

"Across the group, on average, these statistical differences balance out," says Steinman. "But for individual patients, they are potentially important. A lot of individuals would be treated differently either more aggressively or less aggressively using the point-based model."

Steinman notes that the point-based model, which can be completed in a few minutes with pen and paper, was introduced over a decade ago, when computers and personal digital assistants were less powerful and not so common in private medical practices.

"While the point-based system is a substantial improvement over having no standardized method for predicting risk, just about any computer or PDA in use today can calculate the original Framingham model," says Steinman. "This means that your doctor can calculate your risk just as easily using the complex equation, which is likely to be more accurate than the point-based system. So there's not much reason to use the point-based system anymore in most instances."

Steinman cautions that the study was not designed to determine the benefits or harms for individuals who would be treated differently based on the results of the two models.

The study authors note that the next generation of cholesterol guidelines is expected to be released in the near future, and that point-based versions of the new risk model have already been developed, which may result in similar misclassifications.

"With risk prediction models being increasingly used for many different diseases and conditions, this could be a general problem in the field of medicine," predicts Steinman. "In creating simplified risk models, we have to be aware of the potential impact on individual patients."


'/>"/>

Contact: Kristen Bole
kristen.bole@ucsf.edu
415-502-6397
University of California - San Francisco
Source:Eurekalert

Related medicine news :

1. Clinical trials: Comprehension unaffected by simplified consent forms or payment
2. Study Results Validate Shape-HF as Simplified, Portable Cardiopulmonary Exercise Testing System
3. New guidelines to ease sleepless nights
4. Adherence to practice guidelines may reduce bleeding in cirrhosis patients
5. ASTRO publishes whole breast irradiation guidelines
6. New vitamin D guidelines
7. Experts Issue New Guidelines on Breast Cancer Drugs
8. Screening Guidelines Miss Many Kids With High Cholesterol
9. ESMO publishes updated guidelines on cancer care
10. Updated HIV therapy guidelines would reduce risk of transmission, save lives, billions in costs
11. New cancer guidelines: Exercise during and after treatment is now encouraged
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... ... Apple Rehab Shelton Lakes , which specializes in the delivery of sub-acute ... of a disaster drill on October 3rd. , Apple Rehab participated with the Shelton ... well as the Connecticut Long Term Care Mutual Aid Plan (LTC-MAP). The LTC-MAP ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th Annual Kids Fun Run ... This free event, sponsored by Global Healthcare Management’s CEO, Jon Letko, is aimed ... geared towards children of all ages; it is a non-competitive, non-timed event, which is ...
(Date:10/13/2017)... , ... October 13, 2017 , ... “The Journey: From ... every danger possible to save lost souls in the Philippines. “The Journey: From the ... is a dedicated teacher of the Bible. She has taught all ages and currently ...
(Date:10/12/2017)... LA (PRWEB) , ... October 12, 2017 , ... Planet ... in the U.S., announced today its plans to open a flagship location in Covington, ... occupy the former Rooms To Go store next to Office Depot in the Holiday ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... leader in post-acute health care, have expanded their existing home health joint venture ... , AccentCare has been operating a joint venture home health company with Asante, ...
Breaking Medicine News(10 mins):
(Date:10/11/2017)... Texas , Oct. 11, 2017  Caris Life ... focused on fulfilling the promise of precision medicine, today ... has joined Caris, Precision Oncology Alliance™ (POA) as its ... cancer centers, the St. Jude Crosson Cancer Institute will ... advance the use of tumor profiling, making cancer treatment ...
(Date:10/7/2017)...   Provista, a proven leader in the ... purchasing power, today announced a new resource area on ... is the online home for case studies, articles ... news releases, slideshows and events. ... resources at their fingertips, viewers can also watch short ...
(Date:10/2/2017)... 2017 Diplomat Pharmacy, Inc. (NYSE: ... Consulting, LLC , and named its founder as Diplomat,s ... Tennessee , will operate under Diplomat ... service offerings for health care partners to include IT ... "In an interoperable world, technology delivers comprehensive ...
Breaking Medicine Technology: