Istituto di Fisiologia Clinica, CNR, Pisa, Italy;
Ther Clin Risk Manag. 2011;7:59-68. doi: 10.2147/TCRM.S16523. Epub 2011 Feb 17.
Multifactor cardiovascular disease is the leading cause of death; besides well-known cardiovascular risk factors, several emerging factors such as mental stress, diet type, and physical inactivity, have been associated to cardiovascular disease. To date, preventive strategies are based on the concept of absolute risk calculated by different algorithms and scoring systems. However, in general practice the patient's data collection represents a critical issue.
A new multipurpose computer-based program has been developed in order to:1) easily calculate and compare the absolute cardiovascular risk by the Framingham, Procam, and Progetto Cuore algorithms; 2) to design a web-based computerized tool for prospective collection of structured data; 3) to support the doctor in the decision-making process for patients at risk according to recent international guidelines.
During a medical consultation the doctor utilizes a common computer connected by Internet to a medical server where all the patient's data and software reside. The program evaluates absolute and relative cardiovascular risk factors, personalized patient's goals, and multiparametric trends, monitors critical parameter values, and generates an automated medical report.
In a pilot study on 294 patients (47% males; mean age 60 ± 12 years [±SD]) the global time to collect data at first consultation was 13 ± 11 minutes which declined to 8 ± 7 minutes at the subsequent consultation. In 48.2% of cases the program revealed 2 or more primary risk factor parameters outside guideline indications and gave specific clinical suggestions to return altered parameters to target values.
The web-based system proposed here may represent a feasible and flexible tool for clinical management of patients at risk of cardiovascular disease and for epidemiological research.
多因素心血管疾病是主要死因；除了众所周知的心血管危险因素外，一些新出现的因素，如精神压力、饮食类型和身体活动不足，也与心血管疾病有关。迄今为止，预防策略基于通过不同算法和评分系统计算的绝对风险概念。然而，在一般实践中，患者的数据收集是一个关键问题。
为了：1）轻松计算和比较 Framingham、Procam 和 Progetto Cuore 算法的绝对心血管风险；2）设计一个基于网络的计算机化工具，用于前瞻性收集结构化数据；3）根据最新的国际指南，为有风险的患者提供决策支持，开发了一种新的多用途基于计算机的程序。
在医疗咨询期间，医生使用连接互联网的普通计算机连接到医疗服务器，所有患者的数据和软件都存储在该服务器上。该程序评估绝对和相对心血管危险因素、个性化患者目标和多参数趋势，监测临界参数值，并生成自动医疗报告。
在一项针对 294 名患者（47%为男性；平均年龄 60 ± 12 岁[±SD]）的试点研究中，首次就诊时收集数据的总时间为 13 ± 11 分钟，随后就诊时缩短至 8 ± 7 分钟。在 48.2%的情况下，程序显示 2 个或更多主要危险因素参数超出指南指示范围，并给出了具体的临床建议，将改变的参数恢复到目标值。
这里提出的基于网络的系统可能是一种可行且灵活的工具，可用于管理有心血管疾病风险的患者，并进行流行病学研究。
