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Review
. 2015 Apr 7;65(13):1361-1368.
doi: 10.1016/j.jacc.2015.01.043.

Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines

Seth S Martin  1 , Laurence S Sperling  2 , Michael J Blaha  3 , Peter W F Wilson  2 , Ty J Gluckman  4 , Roger S Blumenthal  3 , Neil J Stone  5
Affiliations
Review

Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines

Seth S Martin et al. J Am Coll Cardiol. .

Abstract

Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation.

Keywords: cerebrovascular disease; coronary heart disease; lipid-lowering therapy; myocardial infarction; risk estimation; shared decision making.

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Figures

FIGURE 1
FIGURE 1. Smartphone Screenshot of the 2013 ACC/AHA Guidelines ASCVD Risk Estimator App
Additional screenshots are provided in the Online Appendix 1. The app can also be downloaded from iTunes (16) or Google Play (17), or the web version can be launched from a computer (18). ACC = American College of Cardiology; AHA = American Heart Association; ASCVD = atherosclerotic cardiovascular disease.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Conceptual Framework for CPRD
The clinician-patient risk discussion (CPRD) is an intersection of evidence, clinical judgment, and patient preference. ACC = American College of Cardiology; AHA = American Heart Association; ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium; CRP = C-reactive protein; CV = cardiovascular; LDL-C = low-density lipoprotein cholesterol; SDM = shared decision making.
See this image and copyright information in PMC

References

    1. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889–934. - PubMed
    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. for the 2013 ACC/AHA Cholesterol Guideline Panel Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med. 2014;160:339–43. - PubMed
    1. Stone NJ, Robinson JG, Lichtenstein A. The new cholesterol treatment guidelines. N Engl J Med. 2014;370:1957. - PubMed
    1. Martin SS, Abd TT, Jones SR, Michos ED, Blumenthal RS, Blaha MJ. 2013 ACC/AHA cholesterol treatment guideline: what was done well and what could be done better. J Am Coll Cardiol. 2014;63:2674–8. - PubMed
    1. Martin SS, Blumenthal RS. Concepts and controversies: the 2013 American College of Cardiology/American Heart Association risk assessment and cholesterol treatment guidelines. Ann Intern Med. 2014;160:356–8. - PubMed

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