Cardiovascular disease is a significant problem in the United States, with nearly two out of three people being diagnosed during their lifetime and causing about a quarter of all deaths annually. But what if there was an easy way to identify a patient’s likelihood of cardiovascular disease while there is time to take steps to reduce the risk of heart attacks, strokes and other complications?
An effective approach to prevention exists. Called the atherosclerotic cardiovascular disease (ASCVD) risk score, it can be used on asymptomatic adults starting at age 40 to estimate their risk of heart attack or stroke over the next 10 years. However, most primary care practices lack a systematic approach to calculating ASCVD within their clinical workflow. Without ASCVD risk assessments as part of primary care, patients are not educated about their risk and empowered to participate in shared decision-making about their care and risk reduction opportunities.
A Closer Look at Cardiovascular Disease Risk Evaluations
Since the 1980s, the American College of Cardiology (ACC) and the American Heart Association (AHA) have collaborated on using scientific evidence to develop clinical practice guidelines designed to improve cardiovascular health. Part of this work was the development of the ASCVD Risk Score, which calculates an individual’s 10-year risk of developing atherosclerotic cardiovascular disease including, coronary heart disease (acute MI, heart failure, or angina), cerebrovascular disease (stroke or transient ischemic attack), peripheral vascular disease or aortic atherosclerosis or aneurysm. ASCVD risk calculators factor in age, sex, race, cholesterol levels, blood pressure, medication use, diabetic status, smoking history, family history of heart attacks or heart disease especially before age 60 and use of aspirin therapy to lower the risk of heart problems.
One of the most widely used assessment tools is the ACC’s ASCVD Risk Estimator Plus, which leverages pooled equations that have been validated for estimating ASCVD risk with the general clinical population in the U.S. Other publicly available tools are designed for specific populations, like the Framingham risk score to measure hard coronary heart disease in white adults starting at age 30, Reynolds for women over 45 and China-PAR for Chinese populations. These calculators can be accessed online, or in some cases, like the ASCVD Risk Estimator Plus, available as downloadable apps.
A patient’s score on these assessments will determine whether preventative measures are needed. In the case of the ASCVD risk assessment, the lowest scores may indicate that individuals should eat a healthy diet and exercise to ensure risk stays low, while higher scores may suggest that lipid-lowering medications or more intensive treatment is necessary.
Adopting Cardiovascular Disease Risk Assessments in Primary Care
Considering that cardiovascular disease is preventable, evaluating ASCVD risk should be a key component of primary care. Understanding a patient’s risk is an important first step in lowering the chance they may develop cardiovascular disease and require more extensive treatments later in life. Together, patients and their providers can explore lifestyle changes – from diet and exercise to smoking cessation – and medication that will help address risk factors like high cholesterol or blood pressure. And providers can leverage remote patient monitoring (RPM) to track blood pressure, another important component of the risk score.
Despite the proven impact that knowing these scores can have on patient health, primary care providers are not widely adopting risk assessments as a regular part of patient screenings. The reason: Too many barriers within the practice, which according to one study, included insufficient time, lack of documented clinical workflows to use a calculator, difficulty accessing calculators and not having the necessary information to input into a calculator.
Many primary care providers are unable to automatically calculate ASCVD risk scores because they rely on disparate tools and manual processes. In some cases, physicians assistants and nursing teams have a time-consuming undertaking that includes compiling a list of all at-risk patients, digging around EHRs to find data on each factor for each patient, then calculating scores using a separate app or website. In other cases, doctors may gather the data at the point of care, but not have the ability to automatically generate a risk score. Not having this information available when the patient arrives ultimately cuts into time the doctors can spend focusing on patient care.
Integration of ASCVD risk assessments into EHR workflows with actionable clinical decision support tools is key to ensuring that primary care providers can effectively help patients benefit from early screening and preventative actions. Rather than manually risk stratifying patients, providers should look to solutions that pull relevant data from the EHR into a single view and allow clinicians and the care management team to filter by ASCVD risk and prioritize patients who may be at the highest risk. When clinicians know their patient’s ASCVD risk score, they can better communicate the potential risks, as well as determine if interventions, such as use of statins, or other lifestyle changes are needed.
Cardiovascular disease is not something that occurs rapidly. Risk factors are well known, and in most cases, early intervention can significantly reduce the risk of events such as heart attacks, strokes and death that commonly result from the disease. Prevention – starting at the primary care doctor’s office – is necessary to minimize the onset of cardiovascular disease and the significant number of deaths it causes each year. By integrating proven tools, like ASCVD risk assessments, into clinical workflows, patients and providers can get an early start on identifying potential issues and lessening the chance issues like high blood pressure and cholesterol will turn into significant health events later in life.
Lucienne Ide
Lucienne Marie Ide, M.D., PH.D., is the Founder and Chief Executive Officer of Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences and achieve quality objectives. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.
