Martin Seth S, Sperling Laurence S, Blaha Michael J, Wilson Peter W F, Gluckman Ty J, Blumenthal Roger S, Stone Neil J
Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
J Am Coll Cardiol. 2015 Apr 7;65(13):1361-1368. doi: 10.1016/j.jacc.2015.01.043.
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.
2013年美国心脏病学会/美国心脏协会胆固醇指南的成功实施取决于对临床医生与患者风险讨论（CPRD）的清晰理解。这是临床医生与患者之间关于降低动脉粥样硬化性心血管疾病风险的益处、不良反应、药物相互作用以及患者偏好的对话。该共同决策过程专为一级预防患者设计，确定了他汀类药物对特定患者的适用性。CPRD尊重个人自主权，使患者努力做出符合个人价值观和偏好的明智选择。投入足够时间进行高质量的CPRD，为加强临床医生与患者关系、患者参与度和药物依从性提供了机会。我们回顾了指南推荐的CPRD、共同决策和决策辅助工具的一般概念、作为实施工具的美国心脏病学会/美国心脏协会风险评估器应用程序，并探讨了实施过程中的潜在障碍。
