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Clinician Article

Cardiovascular Risk Assessment: A Systematic Review of Guidelines.



  • Khanji MY
  • Bicalho VV
  • van Waardhuizen CN
  • Ferket BS
  • Petersen SE
  • Hunink MG
Ann Intern Med. 2016 Nov 15;165(10):713-722. doi: 10.7326/M16-1110. Epub 2016 Sep 13. (Review)
PMID: 27618509
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Disciplines
  • Internal Medicine
    Relevance - 7/7
    Newsworthiness - 5/7
  • Cardiology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 4/7

Abstract

Background: Many guidelines exist for screening and risk assessment for the primary prevention of cardiovascular disease in apparently healthy persons.

Purpose: To systematically review current primary prevention guidelines on adult cardiovascular risk assessment and highlight the similarities and differences to aid clinician decision making.

Data Sources: Publications in MEDLINE and CINAHL between 3 May 2009 and 30 June 2016 were identified. On 30 June 2016, the Guidelines International Network International Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and Web sites of organizations responsible for guideline development were searched.

Study Selection: 2 reviewers screened titles and abstracts to identify guidelines from Western countries containing recommendations for cardiovascular risk assessment for healthy adults.

Data Extraction: 2 reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines for Research and Evaluation II instrument, and 1 extracted the recommendations.

Data Synthesis: Of the 21 guidelines, 17 showed considerable rigor of development. These recommendations address assessment of total cardiovascular risk (5 guidelines), dysglycemia (7 guidelines), dyslipidemia (2 guidelines), and hypertension (3 guidelines). All but 1 recommendation advocates for screening, and most include prediction models integrating several relatively simple risk factors for either deciding on further screening or guiding subsequent management. No consensus on the strategy for screening, recommended target population, screening tests, or treatment thresholds exists.

Limitation: Only guidelines developed by Western national or international medical organizations were included.

Conclusion: Considerable discrepancies in cardiovascular screening guidelines still exist, with no consensus on optimum screening strategies or treatment threshold.

Primary Funding Source: Barts Charity.


Clinical Comments

Cardiology

Intriguing, especially for those of us who try to follow guidelines.

Family Medicine (FM)/General Practice (GP)

This article merely highlighted 17 Western guidelines that met criteria as to validity in CV risk assessment. It did not recommend one guideline over another, and there was no consensus as to strategies for screening, target populations, screening tests, or treatment thresholds. I see no useful utility for me and will follow Canadian guidelines where available.

General Internal Medicine-Primary Care(US)

Interesting comparison of CV risk assessment.

General Internal Medicine-Primary Care(US)

Not to be harsh, but this was a difficult article to read (so it must have been a bear for the reviewers to read those trials). I found the results confusing and did not come away with a sense of what factors are important.

General Internal Medicine-Primary Care(US)

Although the total number of articles is way larger than the ones selected, it provides the status of current recommendations. Most of us use our clinical judgement with review of the AHA/ACC guidelines, but consider each patient separate and decide based on individual characteristics rather than global guidelines.

Internal Medicine

This issue certainly bedevils practicing clinicians. Most everyone has a favorite, but it is not the same from MD to MD. While some practitioners know there are competing calculators out there, others do not and only adopt a "favorite" based on some colleague`s recommendation.

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