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IF TWO-THIRDS OF CANADIAN PHYSICIANS MISCLASSIFY HIGH-RISK VASCULAR PATIENTS? WE NEED A BETTER METHOD.

IF TWO-THIRDS OF CANADIAN PHYSICIANS MISCLASSIFY HIGH-RISK VASCULAR PATIENTS - WE NEED A BETTER METHOD

 



Author Block M Matangi, D Armstrong, D Brouillard, A Dillon, A Johri
Kingston, Ontario

Abstract:
BACKGROUND: Gupta and colleagues have data indicating that even highly motivated canadian physicians misclassify two-thirds of high-risk vascular patients. There has to be a better method of identifying high-risk patients? There are multiple risk scores for assessing cardiovascular risk (CV) yet despite good validation and physician knowledge few physicians actually calculate any risk score most likely due to the limited time during a patient encounter. Furthermore, most risk scores underestimate CV risk, especially in Women. Carotid imaging is a simple non-invasive method of assessing the presence or absence of atherosclerosis, an independent marker of CV risk. The purpose of our investigation was to compare the various risk scores with carotid imaging.
METHODS: We compared low and intermediate risk patients using the Framingham risk score (FRS) for coronary events (FRSC) with, the FRS for global CV events (FRSG), the Reynolds risk score (RRS), the JUPITER study criteria and finally carotid imaging. A high-risk carotid study was said to be present if there was carotid plaque using the ARIC study definition.
RESULTS: There were 113 patients, 57 females aged 66.7 ± 9.4 years and 56 males aged 57.2 ± 10.6 year. The results are seen in the table below.
CONCLUSION: Our data indicates that compared with the various vascular risk scores carotid imaging increases the number of high-risk patients in both men and women. We believe that more patients will be appropriately treated with preventative therapies such as Aspirin and Statins if one simply uses carotid imaging.

Table 1.
FEMALES (N=57) FRSC RRS FRSG JUPITER CAROTID
Low risk 48 48 24 40 15
Intermediate risk 9 6 23 0 0
High risk 0 3 10 17 42
MALES (N=56) FRSC RRS FRSG JUPITER CAROTID
Low risk 28 37 13 36 26
Intermediate risk 28 17 26 0 0
High risk 0 2 17 20 30
FRSC=Framingham risk score coronary. RRS=Reynolds risk score. FRSG=Framinghan risk score global.