CHD risk information improves outcomes

Repeatedly talking to patients about their overall risk of coronary disease improves their perception of risk and motivates those at risk to initiate preventative measures, a literature review finds. Researchers reviewed the literature on the impact of providing patients with their global coronary heart disease risk estimation. From 20 studies, which included 14 randomised controlled trials, there were mixed effects related to the intensity of the intervention provided. However, studies with repeated global risk presentation showed small but significant improvements in the 10-year predicted CHD risk, from 0.2% to 2%, which the authors said would be ‘clinically important’ if applied across the population of moderate- to high-risk individuals. In four studies telling patients their global risk increased the accuracy of patients' own perception of their risk by about 10%. The results of the review suggest "that global CHD risk information might contribute to improved CHD prevention by increasing the accuracy of CHD risk perception and motivating individuals at moderate to high risk to plan risk reduction" the researchers concluded. "In combination with repeated risk presentation or repeated counseling, it may also reduce predicted CHD risk and improve lipid levels." Based on their findings, the study authors say clinical guidelines should continue to recommend that all individuals be informed of their global CHD risk as a way of improving the accuracy of risk perception and their intent for therapy. However, they noted that although global CHD risk would ideally motivate individuals with high risk to accept risk-reducing treatments, it would ideally discourage individuals at low risk from seeking unnecessary treatments. An accompanying editorial noted that even though additional studies were needed to determine whether global risk scores resulted in behaviour change or improved clinical outcomes, there was clinical utility in assessing global risk. “Specifically, assessment of global risk is central to clinical decision making regarding initiation and maintenance of therapies and quality assessments when risks and benefits of interventions are in question," they concluded. Arch Intern Med 20120 170:230-239...