Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation.
BACKGROUND
Risk factors for cardiovascular disease can be modified in primary care. Electronic patient record (EPR) systems include embedded cardiovascular risk factor calculators and should facilitate this process.


OBJECTIVE
To observe how the evidence base for assessing and managing cardiovascular risk is implemented in practice.


METHODS
We compared the different risk calculators promoted for calculating cardiovascular risk in primary care using four test cases. We looked to see how these calculators were implemented in primary care EPR systems. We explored through a workshop which risk factors GPs thought were important and felt motivated to address as part of clinical care.


RESULTS
The risk calculators reviewed use different sets of risk factors and the levels of risk calculated for the same test patient profiles vary by up to 100%. The risk factor calculators embedded within UK computer systems all include the Framingham equation though there is variation in interface, default values and patient groups included. GPs showed consensus around the importance of managing smoking, blood pressure, obesity (body mass index), diabetes and cholesterol but also stressed the importance of providing personalized care and exercising professional judgement.


CONCLUSIONS
There appears to be an evidence-base lost in translation. Different guidelines calculate risk differently, and even when the same guideline is used, variation in implementation leads to further variation. Education and development of improved risk calculators should enable the most appropriate calculator to be used for an individual patient; accreditation of implementation could be achieved through the use of a standard set of test cases.
Debar
Safia
S
Division of Community Health Sciences, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
Kumarapeli
Pushpa
P
Kaski
Juan Carlos
JC
de Lusignan
Simon
S
D000368:Aged; D000465:Algorithms; D015897:Comorbidity; D032921:Consensus; D003327:Coronary Disease / Q000453:epidemiology*; D057286:Electronic Health Records; D055317:Evidence-Based Practice; D006126:Group Processes; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D012984:Software; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology