Comparison of Patients Classified as High-Risk between International Cardiovascular Disease Primary Prevention Guidelines

Author:

Chapman Niamh12ORCID,Breslin Monique2,Zhou Zhen23,Sharman James E.2ORCID,Nelson Mark R.2ORCID,McManus Richard J.4ORCID

Affiliation:

1. School of Health Science, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia

2. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia

3. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia

4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK

Abstract

Background: Cardiovascular disease (CVD) primary prevention guidelines classify people at high risk and recommended for pharmacological treatment based on clinical criteria and absolute CVD risk estimation. Despite relying on similar evidence, recommendations vary between international guidelines, which may impact who is recommended to receive treatment for CVD prevention. Objective: To determine the agreement in treatment recommendations according to guidelines from Australia, England and the United States. Methods: Cross-sectional analysis of the National Health and Nutrition Examination Survey (n = 2647). Adults ≥ 40 years were classified as high-risk and recommended for treatment according to Australia, England and United States CVD prevention guidelines. Agreement in high-risk classification and recommendation for treatment was assessed by Kappa statistic. Results: Participants were middle aged, 49% were male and 38% were white. The proportion recommended for treatment was highest using the United States guidelines (n = 1318, 49.8%) followed by the English guidelines (n = 1276, 48.2%). In comparison, only 26.6% (n = 705) of participants were classified as recommended for treatment according to the Australian guidelines. There was moderate agreement in the recommendation for treatment between the English and United States guidelines (κ = 0.69 [0.64–0.74]). In comparison, agreement in recommendation for treatment was minimal between the Australian and United States guidelines (κ = 0.47 [0.43–0.52]) and weak between the Australian and English guidelines (κ = 0.50 [0.45–0.55]). Conclusions: Despite similar evidence underpinning guidelines, there is little agreement between guidelines regarding the people recommended to receive treatment for CVD prevention. These findings suggest greater consistency in high-risk classification between CVD prevention guidelines may be required.

Publisher

MDPI AG

Reference36 articles.

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2. National Vascular Disease Prevention Alliance (2012). Guidelines for the Management of Absolute Cardiovascular Disease Risk, National Heart Foundation of Australia.

3. Guideline for the diagnosis and management of hypertension in adults—2016;Gabb;Med. J. Aust.,2016

4. National Institute for Health and Care Excellence, (NICE) (2021, April 26). Hypertension in Adults: Diagnosis and Management. Available online: https://www.nice.org.uk/guidance/ng136.

5. National Institute of Clinical Excellence (2014). Cardiovascular Disease: Risk Assessment and Reduction, Including Lipid Modification. Clinical Guideline [CG181], National Institute of Clinical Excellence. Available online: https://www.nice.org.uk/guidance/cg181/chapter/1-recommendations#identifying-and-assessing-cardiovascular-disease-cvd-risk-2.

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