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New CVD guideline and risk calculator expected to help millions


Morgan Liotta


21/07/2023 4:00:58 PM

An Australian-specific calculator is a key feature of the toolkit refresh, which targets conditions responsible for one in four deaths each year.

Checking patient's heart with stethoscope
The new ‘gold standard’ Australian-specific CVD risk calculator and updated guideline are endorsed by the RACGP.

After a decade in the making, the new Australian guideline and calculator for assessing and managing cardiovascular disease (CVD) risk are now available, allowing GPs and other healthcare professionals to more accurately predict CVD.
 
Named as an ‘Endorsed Clinical Guideline’ by the RACGP, the toolkit provides up-to-date evidence and guidance on early detection, assessment, and management of CVD risk.
 
The new Australian CVD Risk Calculator, designed to help GPs to better identify all high-risk people in need of treatment, is a key feature of the revamped guidelines.
 
Chair of the RACGP Expert Committee – Quality Care, Professor Mark Morgan, told newsGP the new algorithm represents ‘a significant change’ that will impact the way GPs assess and manage cardiovascular risk.
 
‘The calculator is modelled to be a better predictor of risk. If used, it will mean that cholesterol and blood pressure lowering medications will be better targeted to the people that stand most to gain,’ he said.
 
‘Key differences are that additional risk factors are considered in the new calculator.
 
‘High risk, with recommendations for pharmacotherapy, is now defined as people with 10% or greater risk of a cardiovascular event in the next five years. The age ranges where the calculator can be used have [also] been expanded.’
 
Based on the PREDICT-1° equation, which was developed from a large New Zealand population cohort study, the calculator has been recalibrated and modified for the Australian population and health setting for the first time.
 
It includes optional risk factors not included in the now-replaced Framingham-based equation, including geographical area and a diagnosis of atrial fibrillation.
 
The update aligns with previous expert calls for a new risk assessment algorithm, which would ‘represent an important advance’ since the previous release of the guidelines in 2012.
 
‘Governance systems are urgently needed to ensure outdated risk calculators are decommissioned from clinical software packages and replaced with something more accurate, effective and efficient,’ they stated.
 
While welcoming the new calculator, Professor Morgan points out some barriers to using it.
 
‘It is too complicated to be represented in two-dimensional tables – you now need to use the online calculator,’ he said.
 
‘GPs will find it much easier when their electronic medical software is tooled up to pre-populate the calculator’.
 
In this year’s Federal Budget, the Government committed $1 million in the 2023–24 financial year to commence implementation of the guidelines and embedding of the calculator into GP software.
 
At the guideline’s launch, Federal Health and Aged Care Minister Mark Butler referred to the calculator as ‘the new gold standard’ in assessing the risk of CVD.
 
‘Every day, 117 Australians die from this disease,’ he said. ‘The new guidelines will help medical professionals across the country to provide earlier detection and treatment for the disease, bringing new hope and help to thousands of Australians.’
 
For GPs using the new resources, Professor Morgan said there is ‘more room for clinical judgement’ about the relative impact or severity of risk factors.
 
‘As before there is a need to identify a group of high-risk people for whom treatment is recommended without needing to use the calculator,’ he said.
 
‘This includes people with existing CVD but also people with familial hypercholesterolaemia or moderately severe chronic kidney disease.’
 
Risk modifiers that can reclassify risk, according to Professor Morgan, include ethnicity, family history, renal function, presence of severe mental illness and pre-existing information from coronary artery calcium (CAC) scores.
 
He also noted that the RACGP’s Red Book 10th edition and First Do No Harm guidelines are being finalised to help shared decision making around CAC testing.
 
Developed by the National Heart Foundation on behalf of the Australian Chronic Disease Prevention Alliance, it is estimated the ‘game-changing’ guideline will benefit around eight million Australians from more accurate prediction and prevention of CVD.
 
The Heart Foundation welcomed the launch, saying it will ‘ensure Australians have access to the best quality CVD risk prevention as soon as possible’.
 
‘Many years from now we will look back on this day and note that the new guideline was a major turning point in saving many Australians from cardiovascular disease,’ CEO David Lloyd said.
 
CVD remains high on Australia’s burden of disease list and is estimated to be responsible for one in four deaths. In 2021, CVD was the underlying cause of 42,700 deaths (25% of all deaths).
 
Other key updates to the guideline include:

  • updated and redefined risk categories
  • improved guidance on how to communicate CVD risk to patients
  • specific considerations for Aboriginal and Torres Strait Islander peoples
  • inclusion of female specific risk factors
  • new terminology.
The updated CVD guideline is a collaboration with the Stroke Foundation, Diabetes Australia, and Kidney Health Australia, and aligns with National Health and Medical Research Council standards.
 
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