1. 22 April 2008 Implementing CVD risk assessment in Primary Care Julia Hippisley-Cox Department of Health 22 nd April 2008

2. QRisk © 2008 All rights reserved Objectives Thoughts on presenting risk to patients Practical aspects of implementing CVD risk assessment in Primary Care Patient ‘e’ record access - current realities & future vision

3. 22 nd April 2008 QRisk © 2008 All rights reserved Presenting risk to patients Patients need to know What is my risk of developing CVD? What can I do to reduce my risk? How effective will this be?

4. 22 nd April 2008 QRisk © 2008 All rights reserved How best to present risk? Keep it clear & simple Pictures say a thousand words Absolute AND relative risk Present in context of every day things Give appropriate perspective “ The bad news is your risk has doubled --- the good news is its gone from one in a million to two in a million…..”

5. 22 nd April 2008 QRisk © 2008 All rights reserved What is my risk? CVD risk of 20% over 10 years Take a 100 people like you, and 20 will develop CVD over the next 10 years (and 80 people wont!) Easier to understand than “one in five”

6. 22 nd April 2008 QRisk © 2008 All rights reserved How do I compare? Your risk is three times that of an average risk for a person of your age/sex

7. 22 nd April 2008 QRisk © 2008 All rights reserved Effect of interventions For smokers: what if stop smoking For overweight: what if loose weight High lipids: what if take statins BP treatment: what if BP treated If you do all of these But modelling the ‘what if’s” complex

8. 22 nd April 2008 QRisk © 2008 All rights reserved CVD Risk Assessment Tool Kit On line web calculator for patients for self assessment Downloadable risk calculator for docs Risk stratification tools for primary care MUST be v simple to use, quick, accessible and make best use existing data MUST get the RIGHT people and not widen health inequalities

9. 22 nd April 2008 QRisk © 2008 All rights reserved Risk stratification tool kit –key goals Utilities for all general practices to to auto-generate a risk recall register based on ‘estimated risk’ Calculate an `actual risk’ within the consultation Present risk and discuss effect of interventions to patients

10. 22 nd April 2008 QRisk © 2008 All rights reserved Risk stratification/recall list Computer search to calculate score for all patients 35-74 Uses estimated values for SBP, BMI, cholesterol/hdl ratio where missing Rank all patients and highlight which patients need what interventions

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12. 22 nd April 2008 QRisk © 2008 All rights reserved Clinical calculation actual risk Utility to calculate ‘actual’ risk in consultation and present it back to patients Explain likely effectiveness of interventions

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16. 22 nd April 2008 QRisk © 2008 All rights reserved Personalised plan & printable prescriptions ItemMy risksMy goalsMy actions 10 year risk of CVD27 % (ie 27 out of 100) Reduce this by halfMore exercise See GP 2 months Smoking20 /dayStop smokingAttend new leaf Blood pressure155/87mmHgLower it < 140/90mmHg Take tablets Body mass index37 kg/m2Ideal <26Loose weight attend weight group Cholesterol6.2 mmols/lIdeal <5mmols/lLow fat diet take statins if no better eGFR (kidney test)58>89Need further tests Random Glucose7.3mmols/l<6mmols/lNeed further tests

17. 22 nd April 2008 QRisk © 2008 All rights reserved Quote from a GP in London “Obviously, the knowing the absolute risk reduction from treatment is essential for a patient to make an informed decision as to whether or not to accept treatment. We are currently doing them a great disservice, by not providing them with better information”.