Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.
Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
Eur Heart J Acute Cardiovasc Care. 2020 Aug;9(5):522-532. doi: 10.1177/2048872619858285. Epub 2019 Jun 25.
Risk assessment and risk prediction have become essential in the prevention of cardiovascular disease. Even though risk prediction tools are recommended in the European guidelines, they are not adequately implemented in clinical practice. Risk prediction tools are meant to estimate prognosis in an unbiased and reliable way and to provide objective information on outcome probabilities. They support informed treatment decisions about the initiation or adjustment of preventive medication. Risk prediction tools facilitate risk communication to the patient and their family, and this may increase commitment and motivation to improve their health. Over the years many risk algorithms have been developed to predict 10-year cardiovascular mortality or lifetime risk in different populations, such as in healthy individuals, patients with established cardiovascular disease and patients with diabetes mellitus. Each risk algorithm has its own limitations, so different algorithms should be used in different patient populations. Risk algorithms are made available for use in clinical practice by means of - usually interactive and online available - tools. To help the clinician to choose the right tool for the right patient, a summary of available tools is provided. When choosing a tool, physicians should consider medical history, geographical region, clinical guidelines and additional risk measures among other things. Currently, the U-prevent.com website is the only risk prediction tool providing prediction algorithms for all patient categories, and its implementation in clinical practice is suggested/advised by the European Association of Preventive Cardiology.
风险评估和风险预测已成为预防心血管疾病的重要手段。尽管欧洲指南推荐使用风险预测工具,但在临床实践中并未得到充分应用。风险预测工具旨在以公正和可靠的方式估计预后,并提供有关结果概率的客观信息。它们支持关于启动或调整预防药物的知情治疗决策。风险预测工具有助于向患者及其家属进行风险沟通,这可能会提高他们改善健康的承诺和动力。多年来,已经开发出许多风险算法来预测不同人群(如健康个体、已确诊心血管疾病患者和糖尿病患者)的 10 年心血管死亡率或终生风险。每种风险算法都有其自身的局限性,因此不同的算法应在不同的患者群体中使用。风险算法通过(通常是交互式和在线可用的)工具在临床实践中得以应用。为了帮助临床医生为合适的患者选择合适的工具,提供了可用工具的摘要。在选择工具时,医生应考虑病史、地理位置、临床指南和其他风险措施等因素。目前,U-prevent.com 网站是唯一一个为所有患者类别提供预测算法的风险预测工具,其在临床实践中的应用得到了欧洲预防心脏病学协会的建议/推荐。