Download Cardiovascular and Diabetes Risk Assessment

Primary Care Handbook (2012) Cardiovascular Steering Group Meeting Summary
Date:
Time:
Location:
Attendees
Tuesday 5 August 2013
9.00 to 4.00pm
Wellington Airport Conference Centre
Gregor Coster (Chairperson)
Norman Sharpe
Les Toop
Rod Jackson
Andrew Hamer
Jim Vause
Graeme Smith
Allie Crombie
Helen Rodenburg
Karen Evison
Lucia Bercinskas
1. General discussion
a. There has been a good level of interest in the CVDRA update, including feedback from recent
conferences
b. CVD risk tools were discussed and their contribution to informed decision making and shared
care
c. Risks versus benefits – what works to create the greatest benefit? Do we need a quality
improvement framework?
d. The use of absolute numbers as a means for quality improvement is not necessarily a measure in
that primary care which encompasses more than single items.
e. The new resource is for clinicians and not performance targets
f. Advice should indicate the high and low intervention / treatment zones with supporting numbers
g. Clinical judgment and patient preference influences the management of CVDRA
h. Do we need a decision support tool that calculated death or CVD event?
i. Do we need an indicator zone with numbers and appropriate treatment / information?
j. The conclusion will be the development of CVDRA resource with indicator zones
2. Key points:
a. Assessments are a point on the continuum of CVD risk. Therefore, one cut off thresholds such
as 15% is no longer considered appropriate; rather discussion should occur with all people and
management intensity graded according to a series of risk ranges
b. Shared treatment decisions should form the basis of managing cardiovascular risk, taking into
account an individual’s estimated 5-year combined 1 cardiovascular risk and the magnitude of absolute
benefits and the harms of interventions. It is recognized people will have their own risk thresholds
c.
The overall goal is to reduce cardiovascular risk for individuals and provide appropriate advice
about reducing the risk of developing diabetes
d. For people over 75 years of age consideration of the likely risks and benefits of treatment should
be taken into account including personal values, comorbidities, and life expectancy. There is
limited good quality evidence to support firm recommendations for medications in primary
prevention for those over 75
3. Handbook review:
a. The group worked through the existing handbook identifying areas to update and clarify. Statin
prescribing advice was agreed
b. There was also discussion about non face to face CVDRA and requirements for that to occur
1
The word “combined” is used to reflect the calculated risk based on the combined effects of known cardiovascular risk factors.
1
4. Design, Publication, Implementation of the CVDRA Resource
a. Reminder that in 2014 the new CVD risk equations will be available and any outstanding issues
will be addressed s part of the implementation process around that
b. Production of resource – prototype A5 max five pages (10 sides)
c. Inclusion of a quick reference index
d. Resource foreword to include increased patient participation, no fundamental change in
medications
e. Sector Consultation two weeks – electronically send to interested parties asking them to identify
and feedback on major issues
f. Teleconference to finalise the content with the Steering Group date to be confirmed
g. Publicity for new resource to be arranged
2