EPIRxISK™

Cardiovascular Risk Calculator

Introduction

Welcome! This is the cardiovascular risk calculator that was used in the Alberta RxEACH study (1).

This calculator is intended as a tool to assess cardiovascular risk and engage patients in managing their risk factors. It uses 3 different risk engines depending on the patient's medical history i.e. if he/she has diabetes, vascular disease, chronic kidney disease or none of those conditions. In the case where more than 1 risk engine could be used (e.g., patient has diabetes and vascular disease), the system will default to use the risk engine generating the highest risk.

About RxEACH Study

Briefly, RxEACH was a randomized trial of pharmacist prescribing and care in patients at high risk for cardiovascular events (1). High risk patients (those with diabetes, vascular disease, chronic kidney disease, or high (>20%) Framingham Risk primary prevention) were identified by their community pharmacist. A total of 56 pharmacies in Alberta, Canada participated. Patients randomized to the intervention group received a comprehensive assessment and management of their cardiovascular risk factors by their pharmacist, including prescribing, laboratory assessment, and monthly follow-up for 3 months. Patients in the control group received usual care by their pharmacist and physician for 3 months. The primary outcome, reduction in estimated risk for cardiovascular events (calculated using this risk calculator) was a 21% reduction in the intervention group, compared to usual care (p<0.001). There were also significant reductions in blood pressure, cholesterol, smoking and an improvement in glycemic control in those with diabetes (1). More information on the RxEACH study is available at https://www.epicore.ualberta.ca/home/RxEACH/.

How to use EPIRxISK™

  • Enter as many of the patient demographics as you can.
  • Based upon the information that you enter, the system will choose the most appropriate risk engine (for those with diabetes, it will choose the UKPDS (2) risk engine. For those with vascular disease (cerebrovascular disease, coronary disease, peripheral arterial disease), it will choose the SMART risk score (3), for those with chronic kidney disease or primary prevention (no known vascular disease or diabetes), the system will use the Framingham Risk Score (4). Please note that since there is no validated risk engine for chronic kidney disease, for those with CKD and no diabetes or vascular disease, the estimate using Framingham will likely be lower than the true risk.
  • The system will give you an estimated risk for cardiovascular events.
  • "Risk” refers to the risk of a major cardiovascular event in the next 10 years. Major cardiovascular events include: cardiovascular death, myocardial infarction, other acute coronary syndromes, and revascularization.
  • The pie chart to the right will also show you the contribution of each risk factor to the overall cardiovascular risk. This can be helpful when discussing risk management with patients (they might choose to work on the risk factor which is contributing the most to the cardiovascular risk).
  • You can print out the diagram for your patient.
  • We also suggest that you use the sliders to modify the risk factor(s) to show patients how risk factor modification can improve cardiovascular risk (you can also print the “modified” scenario to help motivate your patient).

Contact Us

Please get in touch if you have any feedback, questions or concerns.


 

 

 

 



References

  1. Tsuyuki RT, Al Hamarneh YN, Jones CA, Hemmelgarn BR. Effectiveness of Community Pharmacist Prescribing and Care on Cardiovascular Risk Reduction: Randomized Controlled RxEACH Trial. Journal of the American College of Cardiology (2016), doi: 10.1016/j.jacc.2016.03.528.
  2. The risk calculators are based upon the following risk engines:

  3. Stevens RJ, Kothari V, Adler AI, Stratton IM, Holman RR. The UKPDS risk engine: a model for the risk of coronary heart disease in type 2 diabetes (UKPDS 56). Clin Sci 2001; 101: 671-9.
  4. Dorresteijn JAN, Visseren FLJ, Wassink AMJ et al. Development and validation of a prediction rule for recurrent vascular events based on a cohort study in patients with arterial disease: the SMART risk score. Heart 2013; 99:866-872.
  5. D’Agostino RB, Vasan RS, Pencina MJ et al. General cardiovascular risk profile for use in primary care: The Framingham heart study. Circulation 2008; 117:743-53.


In the case of patients qualifying for the use of more than one risk engine (e.g., for those with diabetes and vascular disease), the RxEACH risk engine will calculate the risk using both engines and report only the results from the engine indicating the highest risk.