Clinical utility of a novel coronary heart disease risk-assessment test to further classify intermediate-risk patients.
BACKGROUND
Current coronary heart disease (CHD) risk assessments inadequately assess intermediate-risk patients, leaving many undertreated and vulnerable to heart attacks. A novel CHD risk-assessment (CHDRA) tool was developed for intermediate-risk stratification using biomarkers and established risk factors to significantly improve CHD risk discrimination.


OBJECTIVE
Physicians will change their treatment plan in response to more information about a patient's CHD risk level provided by the CHDRA test.


METHODS
A Web-based survey of cardiology, internal medicine, family practice, and obstetrics/gynecology physicians (n = 206) was conducted to assess the CHDRA clinical impact. Each physician was shown 3 clinical vignettes representing community-based cohort participants randomly selected from 8 total vignettes. For each, the physicians assessed the individual's CHD risk and selected preferred therapies based on the individual's comorbidities, physical examination, and laboratory results. The individual's CHDRA score was then provided and the physicians were queried for changes to their initial treatment plans.


RESULTS
After obtaining the CHDRA result, 70% of the physician responses indicated a change to the patient's treatment plan. The revised lipid-management plans agreed more often (74.6% of the time) with the current Adult Treatment Panel III guidelines than did the original plans (57.6% of the time). Most physicians (71.3%) agreed with the statement that the CHDRA result provided information that would impact their current treatment decisions.


CONCLUSIONS
The CHDRA test provided additional information to which physicians responded by more often applying appropriate therapy and actions aligned with guidelines, thus demonstrating the clinical utility of the test.
Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Matthew D
MD
Solomon
Ahalya
A
Tirupsur
Evangelos
E
Hytopoulos
Michael
M
Beggs
Douglas S
DS
Harrington
Cynthia
C
French
Thomas
T
Quertermous
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
D015415:Biomarkers