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Randomized Controlled Trial
. 2021 Apr;214(6):266-271.
doi: 10.5694/mja2.50960. Epub 2021 Feb 23.

Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic

J Andrew Black  1   2 , Julie A Campbell  1 , Serena Parker  2 , James E Sharman  1 , Mark R Nelson  3 , Petr Otahal  1 , Garry Hamilton  4 , Thomas H Marwick  5
Affiliations
Randomized Controlled Trial

Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic

J Andrew Black et al. Med J Aust. 2021 Apr.

Abstract

Objectives: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.

Design: Prospective, randomised, open label, blinded endpoint study.

Setting: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.

Participants: Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥ 8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded.

Main outcome measures: The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events.

Results: The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group.

Conclusions: An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores.

Trial registration: Australia New Zealand Clinical Trial Registry, ACTRN12617000615381 (retrospective).

Keywords: Absolute risk; Preventive medicine; Risk factors.

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References

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