Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Clin Cardiol. 2013 Oct;36(10):621-7. doi: 10.1002/clc.22185. Epub 2013 Aug 8.
Current coronary heart disease (CHD) risk assessments inadequately assess intermediate-risk patients, leaving many undertreated and vulnerable to heart attacks. A novel CHD risk-assessment (CHDRA) tool was developed for intermediate-risk stratification using biomarkers and established risk factors to significantly improve CHD risk discrimination.
Physicians will change their treatment plan in response to more information about a patient's CHD risk level provided by the CHDRA test.
A Web-based survey of cardiology, internal medicine, family practice, and obstetrics/gynecology physicians (n = 206) was conducted to assess the CHDRA clinical impact. Each physician was shown 3 clinical vignettes representing community-based cohort participants randomly selected from 8 total vignettes. For each, the physicians assessed the individual's CHD risk and selected preferred therapies based on the individual's comorbidities, physical examination, and laboratory results. The individual's CHDRA score was then provided and the physicians were queried for changes to their initial treatment plans.
After obtaining the CHDRA result, 70% of the physician responses indicated a change to the patient's treatment plan. The revised lipid-management plans agreed more often (74.6% of the time) with the current Adult Treatment Panel III guidelines than did the original plans (57.6% of the time). Most physicians (71.3%) agreed with the statement that the CHDRA result provided information that would impact their current treatment decisions.
The CHDRA test provided additional information to which physicians responded by more often applying appropriate therapy and actions aligned with guidelines, thus demonstrating the clinical utility of the test.
目前的冠心病（CHD）风险评估不能充分评估中危患者，导致许多患者治疗不足，容易发生心脏病发作。一种新的 CHD 风险评估（CHDRA）工具利用生物标志物和已建立的风险因素来进行中间风险分层，从而显著提高 CHD 风险的区分能力。
医生会根据 CHDRA 测试提供的有关患者 CHD 风险水平的更多信息来改变其治疗计划。
对心脏病学、内科、家庭实践和妇产科医生（n = 206）进行了基于网络的调查，以评估 CHDRA 的临床影响。每位医生都查看了 3 个临床病例，这些病例代表了从 8 个总病例中随机选择的社区队列参与者。对于每个病例，医生根据患者的合并症、体检和实验室结果评估个体的 CHD 风险，并根据个体的合并症选择首选疗法。然后提供个体的 CHDRA 评分，并询问医生是否改变其初始治疗计划。
获得 CHDRA 结果后，70%的医生答复表明改变了患者的治疗计划。修订后的血脂管理计划与当前的成人治疗小组 III 指南更一致（74.6%的时间），而原始计划则不一致（57.6%的时间）。大多数医生（71.3%）同意这样的说法，即 CHDRA 结果提供了可能影响其当前治疗决策的信息。
CHDRA 测试提供了更多的信息，医生通过更频繁地应用适当的治疗方法和与指南一致的行动来做出回应，从而证明了该测试的临床实用性。
