New CV Guidelines: Are You a Follower?
Editor's Note:
Between February 11 and 17, 2014, Medscape invited primary care physicians (PCPs) and cardiologists to participate in an online survey asking for their reaction to the new cardiovascular (CV) risk calculator and cholesterol guidelines, as well as the multiple hypertension advisories. More than 230 PCPs (64% male) and 208 cardiologists (84% male) responded. Most respondents were in an office-based practice setting (61% of cardiologists and 52% of PCPs), and 21% were hospital-based.
If the findings from this survey can be extrapolated to the broader cardiology/primary care community, then there is good awareness of the new cholesterol guidelines and risk calculator, but there remains confusion and a lack of consensus on how to incorporate them into practice. The release of conflicting hypertension advisories has merely compounded matters.
In a commentary on theheart.org | Medscape Cardiology, Dr. Seth Bilazarian notes that clinicians in the field are often criticized for not following guidelines, but you "can't fault practitioners for failing to promptly adopt guidelines when they come out infrequently, and with capricious recommendations."
(Enlarge Image)
Figure 1.
Use of the new CV risk calculator.
The 2013 American College of Cardiology (ACC)/ American Heart Association (AHA) Guideline on the Assessment of Cardiovascular Risk marked the release of an updated CV risk calculator. The new tool was based on more diverse populations than prior calculators and estimates the risk for first atherosclerotic CV disease (ASCVD) event -- defined as coronary heart disease death, or fatal or nonfatal stroke -- over a 10-year period among people initially free of ASCVD.
Before you could download the app, the critics were out in force with accusations that the algorithm overestimates risk in both US and European populations. In the Lancet (and the New York Times), Drs. Paul Ridker and Nancy Cook noted that "virtually all men older than 66 years and women older than 70 years have a calculated 10-year risk greater than 7.5%, even with optimal risk factors." This would render them candidates for statin therapy per the new cholesterol management guidelines.
Over 40% of cardiologists and PCPs surveyed were familiar with the new CV risk calculator but are not using it. Approximately one third are using it on some of their patients, and 16% say they use it on all their patients.
When shown the survey results, theheart.org|Medscape Cardiology Advisory Board Member Dr. Henry Black (New York University School of Medicine) was actually surprised at how many had heard of the new risk calculator. And although he believes "the new one is a little better than the old one," he emphasized that "calculators are problematic when you are dealing with an individual patient rather than a population."
Editor's Note:
Between February 11 and 17, 2014, Medscape invited primary care physicians (PCPs) and cardiologists to participate in an online survey asking for their reaction to the new cardiovascular (CV) risk calculator and cholesterol guidelines, as well as the multiple hypertension advisories. More than 230 PCPs (64% male) and 208 cardiologists (84% male) responded. Most respondents were in an office-based practice setting (61% of cardiologists and 52% of PCPs), and 21% were hospital-based.
If the findings from this survey can be extrapolated to the broader cardiology/primary care community, then there is good awareness of the new cholesterol guidelines and risk calculator, but there remains confusion and a lack of consensus on how to incorporate them into practice. The release of conflicting hypertension advisories has merely compounded matters.
In a commentary on theheart.org | Medscape Cardiology, Dr. Seth Bilazarian notes that clinicians in the field are often criticized for not following guidelines, but you "can't fault practitioners for failing to promptly adopt guidelines when they come out infrequently, and with capricious recommendations."
(Enlarge Image)
Figure 1.
Use of the new CV risk calculator.
The 2013 American College of Cardiology (ACC)/ American Heart Association (AHA) Guideline on the Assessment of Cardiovascular Risk marked the release of an updated CV risk calculator. The new tool was based on more diverse populations than prior calculators and estimates the risk for first atherosclerotic CV disease (ASCVD) event -- defined as coronary heart disease death, or fatal or nonfatal stroke -- over a 10-year period among people initially free of ASCVD.
Before you could download the app, the critics were out in force with accusations that the algorithm overestimates risk in both US and European populations. In the Lancet (and the New York Times), Drs. Paul Ridker and Nancy Cook noted that "virtually all men older than 66 years and women older than 70 years have a calculated 10-year risk greater than 7.5%, even with optimal risk factors." This would render them candidates for statin therapy per the new cholesterol management guidelines.
Over 40% of cardiologists and PCPs surveyed were familiar with the new CV risk calculator but are not using it. Approximately one third are using it on some of their patients, and 16% say they use it on all their patients.
When shown the survey results, theheart.org|Medscape Cardiology Advisory Board Member Dr. Henry Black (New York University School of Medicine) was actually surprised at how many had heard of the new risk calculator. And although he believes "the new one is a little better than the old one," he emphasized that "calculators are problematic when you are dealing with an individual patient rather than a population."