Heart to Heart: A Computerized Decision Aid for Assessment
Heart to Heart is a computer-based decision aid for patients and providers that provides personalized, evidence-based information about coronary heart disease (CHD) risk and potential risk-reducing interventions. To develop Heart to Heart, the authors used Framingham risk equations and systematic reviews of risk-reducing interventions. The Web version was programmed using PHP: Hypertext Processor, a Web-based programming language, and has separate interfaces for providers and patients. The authors subsequently developed a modified version for personal digital assistants. Heart to Heart uses information about a patient's CHD risk factors (age, gender, total and high-density lipoprotein cholesterol levels, diabetes, smoking, systolic blood pressure, and left ventricular hypertrophy) to calculate risk of total CHD events over 5 or 10 years. Patients and providers can then examine the effect of introducing one or more risk-reducing interventions (aspirin, lipid-lowering drug therapy, antihypertensive medication, or smoking cessation) on the patient's CHD risk. Future research will be directed to determining whether Heart to Heart can improve utilization of effective CHD risk-reducing interventions.
Coronary heart disease (CHD) is the leading cause of death in the United States. In 2003, more than 1.1 million Americans experienced new or recurrent myocardial infarction or fatal CHD. About one third of these events were fatal, and approximately 540,000 of these events were first myocardial infarctions. The estimated direct and indirect costs of CHD and stroke for 2003 were projected to be $130 billion.
Fortunately, effective therapies are available to reduce the risk of initial CHD events. Multiple, high-quality cohort studies have shown the benefits of smoking cessation, including a reduction in CHD risk. Recent systematic reviews of randomized trials have shown that aspirin, 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors (statins), and antihypertensive agents can reduce CHD events for patients with no previous history of cardiovascular events. The relative risk reductions for these therapies appear to be nearly constant across the range of underlying CHD risk. Thus, the absolute benefit of these treatments is proportional to the patient's underlying CHD risk.
Previous studies have shown that providers are not able to estimate patients' absolute CHD risk accurately on their own; however, CHD risk can be estimated using risk equations derived from large prospective cohort studies such as the Framingham Heart Study. Several charts and computer programs have been developed to help providers calculate CHD risk using the Framingham data. Although such tools are useful means of determining risk, none have included the ability to accurately calculate and examine the potential benefit of applying different combinations of risk-reducing treatments.
Information on the potential benefits of risk-reducing interventions is important for efforts to reduce the burden of CHD-related illness. Currently, many well tested risk-reducing therapies are underutilized. Recent data suggest that only 30% of adults over age 50 years are using aspirin, 25% have adequate control of hypertension, 37% of those with lipid abnormalities and other CHD risk factors have low-density lipoprotein cholesterol values below 130 mg/dL, and 70% of smokers seen in primary care settings have received advice to quit from their providers within the past year.
To improve awareness of CHD risk and the potential benefits of different risk-reducing treatments, we developed a computer-based CHD decision tool called Heart to Heart that provides information for, and facilitates communication between, patients and providers.
Heart to Heart is a computer-based decision aid for patients and providers that provides personalized, evidence-based information about coronary heart disease (CHD) risk and potential risk-reducing interventions. To develop Heart to Heart, the authors used Framingham risk equations and systematic reviews of risk-reducing interventions. The Web version was programmed using PHP: Hypertext Processor, a Web-based programming language, and has separate interfaces for providers and patients. The authors subsequently developed a modified version for personal digital assistants. Heart to Heart uses information about a patient's CHD risk factors (age, gender, total and high-density lipoprotein cholesterol levels, diabetes, smoking, systolic blood pressure, and left ventricular hypertrophy) to calculate risk of total CHD events over 5 or 10 years. Patients and providers can then examine the effect of introducing one or more risk-reducing interventions (aspirin, lipid-lowering drug therapy, antihypertensive medication, or smoking cessation) on the patient's CHD risk. Future research will be directed to determining whether Heart to Heart can improve utilization of effective CHD risk-reducing interventions.
Coronary heart disease (CHD) is the leading cause of death in the United States. In 2003, more than 1.1 million Americans experienced new or recurrent myocardial infarction or fatal CHD. About one third of these events were fatal, and approximately 540,000 of these events were first myocardial infarctions. The estimated direct and indirect costs of CHD and stroke for 2003 were projected to be $130 billion.
Fortunately, effective therapies are available to reduce the risk of initial CHD events. Multiple, high-quality cohort studies have shown the benefits of smoking cessation, including a reduction in CHD risk. Recent systematic reviews of randomized trials have shown that aspirin, 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors (statins), and antihypertensive agents can reduce CHD events for patients with no previous history of cardiovascular events. The relative risk reductions for these therapies appear to be nearly constant across the range of underlying CHD risk. Thus, the absolute benefit of these treatments is proportional to the patient's underlying CHD risk.
Previous studies have shown that providers are not able to estimate patients' absolute CHD risk accurately on their own; however, CHD risk can be estimated using risk equations derived from large prospective cohort studies such as the Framingham Heart Study. Several charts and computer programs have been developed to help providers calculate CHD risk using the Framingham data. Although such tools are useful means of determining risk, none have included the ability to accurately calculate and examine the potential benefit of applying different combinations of risk-reducing treatments.
Information on the potential benefits of risk-reducing interventions is important for efforts to reduce the burden of CHD-related illness. Currently, many well tested risk-reducing therapies are underutilized. Recent data suggest that only 30% of adults over age 50 years are using aspirin, 25% have adequate control of hypertension, 37% of those with lipid abnormalities and other CHD risk factors have low-density lipoprotein cholesterol values below 130 mg/dL, and 70% of smokers seen in primary care settings have received advice to quit from their providers within the past year.
To improve awareness of CHD risk and the potential benefits of different risk-reducing treatments, we developed a computer-based CHD decision tool called Heart to Heart that provides information for, and facilitates communication between, patients and providers.
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