Risk assessment of coronary heart disease (CHD) in the office
Clinicians can easily classify in their patients the long-term risk of coronary heart disease (CHD) and other cardiovascular events (SSSob) as very high, high, intermediate or low based on answers to a few simple questions and manipulations, such as measuring blood pressure. An algorithm was developed that allows to classify patients according to their total cardiovascular risk (SSR).
The patient’s cardiovascular status is the first issue of the algorithm. If the patient has cardiovascular disease (CVD), then it is necessary to determine whether it is stable. If yes, then further classification is not necessary, because this patient by definition has a very high long-term risk and needs an “aggressive” modification of a risk factor (RF).
The presence of instability, such as unstable angina (NS), indicates a high short-term risk. Unstable patients need immediate referral for appropriate diagnostic studies and interventions. Even after the stabilization of the debt state, the acute risk of these patients is very high.
If the patient does not have an established CVD, but there are worrisome symptoms (for example, recurring chest pain, suggesting CVD or another CVD), then this patient also needs to be evaluated using appropriate diagnostic tests to detect high short-term risk. If CVD is diagnosed, the patient should undergo further examination, for example, catheterization or other intervention (if necessary), and further should be assigned to a very high risk group. If the results of this examination are negative, the patient is returned to the primary prevention group for risk assessment.
For those who do not have CVD, the key point is the presence of diabetes. If diabetes is diagnosed, then the long-term risk is high and the patient should be classified as a high-risk group for primary prevention. According to the algorithm, patients without obvious CVD or diabetes must undergo a test to determine the 10-year risk of CVD using a simple prognostic tool, such as the Framingham Risk Scale or another similar scale.
Patients with very high Framingham Risk Scores (CSD risk for 10 years> 20%) are also at high risk. On the other side of the spectrum are patients whose risk factors (DF) are <2 or the Framingham risk score is <5%. These patients are classified as low risk.
According to the algorithm, for patients who fall into the intermediate group or are between high and intermediate risk (10-year risk is 5-15%), clinicians may collect additional information for better stratification: conduct a secondary screening if it is unclear how “aggressive” there should be an intervention aimed at FR. The next step for such patients is to determine the level of CRP, and a more expensive and complicated method may be a test for TFN or EDT to determine the calcium content in the coronary arteries (DND and USPSTF approved the prescription of the FN test for a prevention decision).
Each of these tests provides additional information to the Framingham Risk Scale. CRP may be helpful, but it is unlikely that intervention will be needed, the significance of which in asymptomatic patients is unknown. The end result will be a more accurate risk assessment and the assignment of the patient to the relevant group (high, intermediate or low risk). Such a general risk classification is useful in choosing an intervention and its intensity.