News | Population Health | December 21, 2018

Population Health Approach Could Dramatically Reduce Heart Disease Risk

Study uses data analytics to identify North Carolinians at risk for cardiovascular disease not identified earlier

Population Health Approach Could Dramatically Reduce Heart Disease Risk

December 21, 2018 — Tens of thousands of people across North Carolina are at high risk of developing cardiovascular disease that had not been identified previously, according to a new study published in Journal of the American Medical Informatics Association.1 The study team, composed of researchers at the University of North Carolina (UNC) School of Medicine and the UNC Gillings School of Global Public Health, created a statewide network of healthcare professionals in urban, suburban, and rural areas who work in small primary care practices and used existing electronic health records to identify at-risk individuals. Primary care doctors across the state then used this analysis to proactively engage patients to reduce their risk.

This first-of-its-kind study was made possible through a $15-million federal grant from the Agency for Healthcare Research and Quality’s (AHRQ) Evidence NOW Program to help primary care practices use the latest evidence to improve the heart health of millions of Americans. UNC’s Heart Health Now! Advancing Heart Health in NC Primary Care project was one of seven grantees back in 2015, and this paper is the first published results from their work.

Heart Health Now! principal investigator Sam Cykert, M.D., professor of medicine in the division of general internal medicine and director of the program on health and clinical informatics at UNC-Chapel Hill, said, “The fact that nearly all patients have digital data now, we can use this information to identify people who are in trouble without necessarily waiting for them to come into the doctor’s office. This is crucial because if we would wait in order to get every single piece of information from them at a doctor’s visit, we would be missing opportunities to do good care and save lives.”

Cykert added, “Over the years, I’ve cared for many people who suffered the debilitating effects of a heart attack or stroke much too early. Because of the lack of sophisticated information systems and processes, doctors could not quickly identify patient risk and prioritize new evidence for care. So many of these folks missed opportunities that could have prevented severe outcomes resulting from premature disease. We now have the systems and processes in place to quickly help many, many people.”

For this study, Cykert and colleagues formed alliances with 219 primary care clinics, 52 percent of which are in rural areas, to examine 345,440 primary care patients age 40 to 79 – the age range that allows providers to calculate formal risk scores. In that patient pool, 108,515 lacked cholesterol scores on their electronic health care records. Without those numbers – total cholesterol plus HDL levels – primary care doctors lack all the criteria to determine precise cardiovascular risk. There are other indicators, of course, such as smoking status, weight, diabetes, exercise regimen, gender, etc.

Cykert and colleagues conducted two kinds of analysis to determine the risk of the patients who lacked cholesterol numbers. They analyzed the data from the 236,925 patients for which doctors did have cholesterol numbers and all other criteria. This allowed Cykert’s team to create an equation to estimate the cholesterol levels of patients with missing cholesterol data. This kind of formal “data imputation” allowed Cykert’s team to determine that 43,205 patients were at high risk of heart disease even though they had never been identified previously.

But that kind of research analysis is not terribly practical for primary care docs running busy practices. So Cykert’s team ran a second simpler analysis: The researchers plugged in very conservative cholesterol numbers for the patients who lacked such data – 170 mg/dl total cholesterol and 50 mg for HDL. “Those are good numbers,” Cykert said. “But still, we determined that because of their other indicators, 40,565 patients were at high risk of heart disease and eligible for risk reduction interventions such as aspirin or statins.”

Over the course of this study, about half of the patients with missing cholesterol data did wind up getting their cholesterol levels checked. “This allowed us to calculate the sensitivity and specificity of our findings. Turns out, using formal imputation did find a few more patients at high risk but at the cost of finding some patients whose risk was overestimated.”

The authors said the formal method actually yielded a lower specificity and a higher false-positive rate than did the conservative estimate of 170 and 50.

“Whether doctors are part of a large health system or in a small rural practice, the fact that all these patients have digital data now means we can identify patients who are at high risk of developing a very serious condition without waiting six months for them to make an appointment. Doctors can engage with these patients immediately and re-engage with them as needed to decrease risk, which is so crucial when it comes to decreasing the number of heart attacks and strokes.”

For more information: www.academic.oup.com/jamia

Reference

1. Cykert S., DeWalt D.A., Weiner B.J., et al. A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ’s EvidenceNow initiative. Journal of the American Medical Informatics Association, Nov. 29, 2018. https://doi.org/10.1093/jamia/ocy151

Related Content

U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
AHA Statement Warns Hookah Smoking May Harm the Heart
News | Cardiac Diagnostics | March 08, 2019
Smoking tobacco in waterpipes, more commonly known as hookahs, results in inhaling toxic chemicals, often at levels...
PTSD Alone Does Not Increase Heart Disease Risk in Veterans
News | Cardiac Diagnostics | February 20, 2019
February 20, 2019 — Post-traumatic stress disorder (PTSD) by itself does not explain the...
Hormone Therapy May Increase Cardiovascular Risk During Gender Transition
News | Cardiac Diagnostics | February 18, 2019
Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular...
Overlay Init