Download Statin-Decision-Balance_4-code-fix

{fn CVRsk() {
local cvr=""
If match(Toupper(OBSANY("SMOK STATUS")),"CURRENT")>0 then cvr=cvr + "Smoking/Tobacco Use"
else "" endif
If OBSANY("HX OF HTN")=="yes" then cvr=cvr + "
Hypertension" else
If ccc_sys_hasdx("ICD-401") then cvr=cvr + "
Hypertension" else "" endif
endif
If ccc_sys_hasdx("ICD-585^ICD-403^ICD-404") then cvr=cvr + "
Chronic Kidney Disease" else "" endif
If ccc_sys_hasdx("ICD-250^ICD-249") then cvr=cvr + "
Diabetes Mellitus" else "" endif
If OBSANY("FH<55MALE MI")=="yes" then cvr=cvr + "
Family History of Heart Disease in a Male before Age 55" else "" endif
If OBSANY("FH<65FEMALMI")=="yes" then cvr= cvr + "
Family History of Heart Disease in a Female before Age 65" else "" endif
If OBSANY("HDL") <40 then cvr=cvr + "
Low HDL, below 40" else "" endif
If OBSANY("CARDCASCORE") <> "" then cvr=cvr + "
Cardiac Calcium Score= " + OBSANY("CARDCASCORE") + " [Normal <300 or <75%]" else "" endif
If OBSANY("CTCARTCASCO") <> "" then cvr=cvr + "
Cardiac Calcium Score= " + OBSANY("CTCARTCASCO") + " [Normal <300 or <75%]" else "" endif
If OBSANY("CRP") <> "" then cvr=cvr + "
C-Reactive Protein(CRP)= " + OBSANY("CRP") + " [Normal <2 mg/ml]" else "" endif
If OBSANY("CRP HI SENS") <> "" then cvr=cvr + "
C-Reactive Protein(High Sensitivity CRP)= " + OBSANY("CRP HI SENS") + " [Normal <2 mg/ml]" else "" endif
If OBSANY("CRP QUANTI") <> "" then cvr=cvr + "
C-Reactive Protein(Quantitative CRP)= " + OBSANY("CRP QUANTI") + " [Normal <2 mg/ml]" else "" endif
If PATIENT.SEX == "M" then
If PATIENT_AGE() >45 then cvr=cvr + "
Male, Age >45" else "" endif
else
If PATIENT_AGE ()>55 then cvr =cvr + "
Female, Age >55" else "" endif
endif
If cvr=="" then cvr="No Major Cardiac Risk Factors Recorded" endif
return cvr
}
}{fn ln(z) {
local a,b,c,d,f
if z<1/2 then return "Cannot find ln of number below 0.5" endif
a=(z-1)/z
d=a
b=a
f=z*10
for t=2, t<f, t=t+1
do
b=b*a
c=(1/t)*b
d=d+c
endfor
return d}
}{fn PCCVRisk() {
local insum,e,w,r,q,s,t,MCV,PCRisk,SMOKSTATUS,DIABSTATUS
cond
case (PATIENT_AGE())<21
return "Patient too young to calculate risk" break
case (OBSANY("CHOLESTEROL"))==""
return "NO Total Cholesterol value in flowsheet" break
case (OBSANY("HDL"))==""
return "No HDL value in Flowsheet" break
case (OBSANY("BP SYSTOLIC"))==""
return "No Systolic BP value in Flowsheet" break
case (PATIENT_AGE())>20
lAGE=ln(PATIENT_AGE())
lCHOL=ln(OBSANY("CHOLESTEROL"))
lHDL=ln(OBSANY("HDL"))
lBPS=ln(OBSANY("BP SYSTOLIC"))
If match(Toupper(OBSANY("SMOK STATUS")),"CURRENT")>0 THEN SMOKSTATUS=1 ELSE
SMOKSTATUS=0 ENDIF
If ccc_sys_hasdx("ICD-250.^ICD-249.") then DIABSTATUS=1 else DIABSTATUS=0 ENDIF
If PATIENT.SEX=="M" then
If MATCH(PATIENT.RACE,"Black")> 0 then MCV=19.54
s=0.8954 //BLACK MALE
If (ccc_sys_hasdx("ICD-401"))=="FALSE" then
insum=2.469*lAGE+0.302*lCHOL+(-0.307)*lHDL+1.809*lBPS+0.549*SMOKSTATUS+0.645*DIABSTATUS
Else
insum=2.469*lAGE+0.302*lCHOL+(-0.307)*lHDL+1.916*lBPS+0.549*SMOKSTATUS+0.645*DIABSTATUS
Endif
Else
MCV=61.18 s=0.9144 //WHITE MALE
If (ccc_sys_hasdx("ICD-401"))=="FALSE" then
insum=12.344*lAGE+11.853*lCHOL+(-2.664)*(lAGE*lCHOL)+(-7.99)*lHDL+1.769*(lAGE*lHDL)+1.764*lBPS+
7.837*SMOKSTATUS+(-1.795)*lAGE*SMOKSTATUS+0.658*DIABSTATUS
Else
insum=12.344*lAGE+11.853*lCHOL+(-2.664)*(lAGE*lCHOL)+(-7.99)*lHDL+1.769*(lAGE*lHDL)+1.797*lBPS+
7.837*SMOKSTATUS+(-1.795)*lAGE*SMOKSTATUS+0.658*DIABSTATUS
Endif
Endif
Else
//FEMALE
If MATCH(PATIENT.RACE,"Black")> 0 then MCV= 86.61 s=0.9533 //BLACK FEMALE
If (ccc_sys_hasdx("ICD-401"))=="FALSE" then
insum=17.114*lAGE+0.94*lCHOL+(-18.92)*lHDL+4.475*(lAGE*lHDL)+27.820*lBPS+(-6.087)*(lAGE*lBPS)+0
.691*SMOKSTATUS+0.874*DIABSTATUS
Else
insum=17.114*lAGE+0.94*lCHOL+(-18.92)*lHDL+4.475*(lAGE*lHDL)+29.291*lBPS+(-6.432)*(lAGE*lBPS)+0
.691*SMOKSTATUS+0.874*DIABSTATUS
Endif
Else
MCV=(-29.18)
s=0.9665 //WHITE FEMALE
If (ccc_sys_hasdx("ICD-401"))=="FALSE" then
insum=(-29.799)*lAGE+4.884*(lAGE*lAGE)+13.540*lCHOL+(-3.114)*(lAGE*lCHOL)+(-13.578)*lHDL+3.149*(l
AGE*lHDL)+1.957*lBPS+7.574*SMOKSTATUS+(-1.665)*lAGE*SMOKSTATUS+0.661*DIABSTATUS
Else
insum=(-29.799)*lAGE+4.884*(lAGE*lAGE)+13.540*lCHOL+(-3.114)*(lAGE*lCHOL)+(-13.578)*lHDL+3.149*(l
AGE*lHDL)+2.019*lBPS+7.574*SMOKSTATUS+(-1.665)*lAGE*SMOKSTATUS+0.661*DIABSTATUS
Endif
Endif
Endif
e=2.71828
w=insum-MCV
r=e^w
q=s^r
PCRisk=(1-q)*100
t= "-Based on: Total Cholesterol = " + (OBSANY("CHOLESTEROL")) + " and HDL= " + (OBSANY("HDL")) +
" and Systolic BP = " + (OBSANY("BP SYSTOLIC")) + fmt( "
Your 10-Year Pooled Cohort Cardiovascular Risk = ","B") + PCRisk +"%"
return t
endcond}
}{fn sys_filter_all(GCIlist) {
// Returns list of Name and date of current meds in allergy list
// that match GPI fragments in list.
// Returns null otherwise.
local meds=getfield(ALL_AFTER("DELIMITED"),"|","")
local types=getfield(GCIlist,"^","")
local r="", i=0, j=0
for j=1, j<=size(meds), j=j+1 do
for i=1, i<=size(types), i=i+1 do
if match(CCC_sys_dp(meds[j],6),types[i])==1
then if r<>"" then r=r+hret endif
r=r+CCC_sys_dp(meds[j],1)+" ("+CCC_sys_dp(meds[j],2)+")" break
else continue
endif
endfor
endfor
return r }
}
Should You Take a Statin Medicine to Prevent Heart Attack and Stroke?
Preventing heart attack and stroke- it's possible!
Cardiovascular (CV) disease can be prevented by avoiding smoking, being physically active, maintaining a
healthy body weight, limiting alcohol and intake of saturated fat, trans fat, cholesterol, and sugars and/or by
taking other medications such as Aspirin. It's important to pay attention to all these factors.
This information sheet focuses on the decision to take a statin in addition to the above.
What are statins for?
Statins are medicines you take daily to lower the cholesterol in the blood and prevent damage to blood
vessels. They lower the risks of having a heart attack or stroke.
Who should consider using statins?
 People who already have disease
Anyone who has ALREADY had a heart attack, stroke or has diabetes should be on a statin. Statins
are proven to help people live longer in this group.
 Healthy Adults at moderate to high risk of developing cardiovascular disease in the next 10
years.
The risk of having a CV event in the next 10 years is evaluated using risk calculators such as the
Framingham Cardiac Risk Score (heart attack only) or Pooled Cohort Risk (heart attack and stroke)
which take into account sex, age, diabetes, smoking status, cholesterol levels and blood pressure.
• High Risk:is more than 20%
• Moderate risk: 10% -20%
• Low risk: is below 7.5%. to 10%
Your Personal Risks:{if ccc_sys_hasdx("ICD-250^ICD-249") then "
-You have Diabetes on your Problem List
" else "" endif}{if
ccc_sys_hasdx("ICD-410^ICD-411^ICD-413^ICD-414^ICD-V45.8^ICD-429.2^ICD-440^ICD-441^ICD-442^IC
D-43^ICD-443.89^ICD-443.9^ICD-443.2^ICD-V15.1") then "
-You have a Cardiovascular Disease diagnosis on your Problem List
" else "
You have the following Major Cardiac Risk Factors:
" + CVRsk() endif + "
" + cond
case CCC_sys_filter_meds("3940")<>""
"-Current Statin on Medlist:
" + CCC_sys_filter_meds("3940")+ "
"
case OBSANY("NOTONSTATIN")<>""
"-Past history Statin declined or contraindicated"
case sys_filter_all("3940")<> ""
"-Allergy list includes a Statin"
else
"-No Statin on Med or Allergy List and No documented contraindication"
endcond + (If OBSANY("CHD 10YR RSK")<>"","
-Your Framingham 10 Year Cardiac Risk was " + OBSANY("CHD 10YR RSK") + " on " +
LASTOBSDATE("CHD 10YR RSK") + "
", "") + "
" + PCCVRisk()
}
Pros and Cons of Taking Statins:
PROS: Some people who take statins will avoid a major heart attack or stroke. Overall, statins are very safe
drugs, and have been studied in people taking them for up to 10 years, so we know a lot about them.
CONS: Some people who take statins will still have a heart attack or stroke (CV) event anyway. Most people
at moderate or high risk will never have a CV event, even if they do not take statins, and this medication can
cause reversible side effects
Benefits of Treatment
Death from All Causes
{if
ccc_sys_hasdx("ICD-410^ICD-411^ICD-413^ICD-4
14^ICD-V45.8^ICD-429.2^ICD-440^ICD-441^ICD-4
42^ICD-43^ICD-443.89^ICD-443.9^ICD-443.2^ICD
Possible Harms of Treatment
Overall 9 out of 10 people have no side effects
Myopathy and Muscle pains
For each 1000 people treated with statins for 4
years,compared to untreated people:
 2 more (0.2%) experience a myopathy
(inflamed muscles.
-V15.1^ICD-250^ICD-249") then "You will live
longer if you take a statin, because you already
have Cardiovascular Disease or Diabetes. For
every 30 people who take a statin, 1 death will be
prevented over 5 years" else "You may not live
longer, but you will have a lower chance of having
a heart attack or stroke" endif}
Reduced Risk of Heart Attack or Stroke
On average,for each 1000 people treated with
statins for 4 years, compared to untreated people:
 10 to 20 more (1-2 %) are protected from
major heart attack events
 5 more (0.5%) are protected from major
cerebrovascular

100 (10% ) experience myalgia (achy
muscles)
9 out of 10 people with muscle aches could still
take a different statin or a different dose.
Abnormal Liver tests
For each 1000 people who took statins, compared
to untreated people:
 5 more (0.5%) experience liver irritation
-that is an elevation of liver enzyme tests-.
Diabetes
For each 1000 people who took statins, compared
to untreated people
 4 more (0.4%) developed diabetes
Number of people out of 1000, who will have a major stroke or heart attack over 10 years follow-up
Patient Risk of a major CV
event
Without
statins
With
statins
Number of bad events
prevented
High risk
250 (25%)
190 (19%)
60 (6%)
Moderate risk
150 (15%)
110 (11%)
40 (4%)
50 (5%)
40 (4%)
10 (1%)
Low risk
Other factors
 Cost of medicine and tests
 Bother of taking medicine daily
 Possible interactions with other foods or medicines (e.g. grapefruit,antibiotics, etc)
 Memory: The FDA labels statins because doctors noticed some rare cases in which statin use may
have been associated with memory loss. These cases were not serious and reversed once the
patient stopped taking the drug. A review by the Mayo Clinic showed in some studies that people
taking statins actually reduce their risk for dementia by 13 percent, their risk for Alzheimer's disease
by 21 percent and their risk for other mental problems by 35 percent.
 Cancer: You may read news stories that say patients on statins have "more" or "less" of certain types
of cancers than people not taking the drugs. Things that are found together do not tell us cause and
effect, only association. In controlled studies of statins, the treated people did not have any higher
rates of cancers. The National Cancer Institute is currently studying statins to prevent colon and skin
cancers. No one knows what the long term effects of these medicines might be in 30 or 40 years.