Correctness of cardiovascular risk assessment in daily clinical practice

ABSTRACT

Issues in the field of prevention of cardiovascular diseases (CVD) which are the leaders in terms of mortality in the world are associated with different methods of assessing cardiovascular risk (CVR) and the accuracy of its determination.

Objective. To assess the correctness of CVR calculations in real clinical practice.

Material and methods. The study involved 252 doctors from 3 regions of Russia: therapists (77%), cardiologists (15%), and other specialties (9%). The average age of the specialists was 38 years and the work experience was 13 years. Doctors assessed CVR based on previously prepared clinical examples using an electronic questionnaire developed for the study with 19 CVD risk factors. Each doctor carried out anonymous assessment of 30 clinical examples using 4 tests: SCORE, Framingham scale, PROCAM, methodology from the Russian recommendations «Diagnostics and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis» VI revision.

Results. It was analyzed 6144 questionnaires and 24 576 assessments on the scales used. Overall, the accuracy of doctors’ assessments was 54%. The doctors assessed most accurately on the Framingham scale. Only 17% of the questionnaires were fully corectly assessed by doctors. Errors related to underestimation of risk (29.5%), overestimation (39.5%) and incorrect use of scales (31%). Cardiologists most accurately determined CVR (62% for the SCORE scale) compared with general practitioners (46%).

Conclusion. It was revealed significant inaccuracies in medical calculations of CVR both as a whole and according to individualscales. The most complex scales give more errors in their practical application. Cardiologists determined CVR most accurately.