Predict the CVD "weather" forecast

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Website : www.yourheartforecast.org.nz

Web reviewer and Auckland GP Jon Wilcox airs his views on the Heart Foundation's latest project, "Your Heart Forecast", a web-based  tool to assess heart attack and stroke risk

Ever since the "world famous in New Zealand" Rod Jackson National Heart Foundation risk tables came out back in the nineties, we have became very familiar with the application of the tool to our patients - so much so that many of us most likely will have a laminated version at eyeball level on our office wall.

The original PC-based tools which were available some 10 years ago, were non web-based and perhaps a little clumsy. Furthermore, at least some PMS vendors showed little interest in developing or improving a durable cardiovascular assessment tool - as simple as such a task would have been.

In line with widespread broadband availability in the consulting room and nurses clinic, the National Heart Foundation has quite recently released a very simple-to-use web-based tool which will give our patients their five year risk on a graph, individualising their risk factor analysis, and with the added bonus of indicating the prognostic effects of simple apathy together with the clear benefits of positive risk factor modification.

The tool can be either used straight off the web through the website, or can also be downloaded as a free PC-based tool.

At this stage, there is limited capacity to merge the report into our PMS systems (with the exception of its integration within Predict), and in this sense could be inferior to other comprehensive programmes such as EDGE.

The recent flyer did hint the tool may eventually be integrated within other electronic decision-support systems within six months or so.

The program has been developed by the University of Auckland through Drs Sue Wells (public health) and Andrew Kerr (cardiology) and is specifically aimed at primary prevention.

Accordingly, a number of exclusions are included at the start of the programme - coronary artery disease, cerebrovascular disease, peripheral vascular disease, diabetic nephropathy, familial and severe hyperlipidaemia, severe hypertension and pregnancy.

"Your Heart Forecast" uses animated graphics to indicate the individual's five year cardiovascular risk by displaying the patient's current risk, their risk relative to the "ideal",  their adjusted cardiovascular age,  forecasting lifetime risk without any lifestyle modification, and forecasting ongoing risk with lifestyle factor modification.

The clear effectiveness for improving motivation with such a quick and graphically informative tool will be apparent to most general practitioners and practice nurses.

Piloted by more than 40 practices
Between March and April this year, "Your Heart Forecast" was piloted in more than 40 practices (from ProCare, Manaia, Te Tai Tokerau, Whangaroa, Kaipara Care, Tihewa Mauriora and Hauora Hokianga PHOs) in Auckland and Northland.

There are a few changes from the heart risk tables - the average blood pressure is requested, which I think is a good re-emphasis.

It also suggests perhaps the importance of some degree of more intensive self-monitoring of blood pressure for patients at significant cardiovascular risk.

There is still the 1996 emphasis on total cholesterol-HDL cholesterol ratios, although we do now have a more modernist approach with greater emphasis on LDL management in recent years. There is also a family history tick box and, importantly, a genetic risk feature provided in the programme concentrating on increased Maori, Polynesian and Indian subcontinental racial risk.

While the lack of a printable format is disappointing, it is probably not an essential requirement for our records as we probably only need to transcribe the calculated five year risk figures to the patient's file - but the inability to print this out to give to our patient, is a definite disadvantage.

This is surely the sort of thing they need to take home to metaphorically speaking "pin up in the pantry".

In the meantime, possibly the best solution might be a simple straight-off-the-screen web-page printout which can be handed out, or re-scanned into the practice filing system if preferred.

The mini-program is very easy to use and accessible - and is very much patient rather than doctor oriented in its emphasis and layout, and deserves to be promoted actively and utilised (quite painlessly) in our day to day preventive health care service delivery.