Primary prevention of heart disease and stroke (or Medical informatics: Let's use it!)
Online posting: Sept. 25, 1997
Published in print: January 13, 1998 (CMAJ 1998;158:23)
Re: Primary prevention of heart disease and stroke: a
simplified approach to estimating risk of events and making drug
treatment decisions, James P. McCormack and colleagues, Can
Med Assoc J 1997;157(4):422-8 [full text / résumé]
See response from: J.P. McCormack and associates
Dr. McCormack and colleagues have published very practical
nomograms for calculating the risk of cardiovascular and
cerebrovascular events in individual patients. These tools are an
example of how treatment decisions can be made rationally, if the
physician has adequate information about risks and benefits.
Unfortunately, such information is often not available at all,
and even when it does exist, it is seldom readily accessible to
clinicians at the point of care.
Given that such access to information is precisely what
clinicians need, it is surprising that the authors view as
cumbersome the use of a computer to calculate risk factors. On
the contrary, computers are among the best tools for obtaining
information. If every physician's office was equipped with a
computer with connections to the Internet, CD-ROMs and other
knowledge sources, the information available at the point of care
would increase substantially, and there would be improvements in
decision-making, patient satisfaction and quality of care.
I therefore strongly encourage the authors to supplement their
nomograms by creating a Web site about the primary prevention of
heart disease and stroke, and updating the site as new studies
are published. Users would enter a patient's age, sex, lipid
levels, blood pressure and other risk factors, and software at
the Web site would calculate the patient's risk of cardiovascular
and cerebrovascular events, as well as the risk reduction
(relative, absolute and "number needed to treat") that could be
expected with therapy to reduce blood pressure or cholesterol
levels.
I also encourage all physicians in Canada to get access to the
Internet, so that they will have more of the information they
need to make informed treatment decisions.
Howard R. Strasberg, MD
Resident in Family Medicine
University of Toronto
Toronto, Ont.
howard.strasberg@utoron
to.ca
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