August 15, 2010
To The Editor,
American Academy of Family Practice Magazine

Re:  Global Risk of Coronary Heart Disease Assessment and Application, August, 2010

I  applaud the authors high lighting of the importance of the global cardiovascular risk calculators.  This is an excellent application for use in an Electronic Health Record (EHR).  With paper charts,  there is no efficient way to calculate  global cardiovascular risk assessment.   

Cardiovascular disease is the number one killer in the United States. The Framingham Cardiovascular Risk Calculators are a robust source of information for patients and providers.  At Southeast Texas Medical Associates (SETMA), my colleagues and I calculate all 12 risk scores, built on the Framingham Study, including the "relative heart age" calculation.  We typically do this at every clinic, nursing home and hospital visit.

The risk calculations are powerful teaching tools (see "Quantifying Global Cardiovascular Risk American Heart Association Statement," July 26, 2007 and "Changing Patient Behavior with Risk Assessment," May 28, 2010, at www.setma.com under "Your Life Your Health) for modifying patient and provider behavior.  With the click of one button, my colleagues and I calculate all 12 risk scores in one second.  Once calculated, the risk scores appear in all disease management tools, whether diabetes, dyslipidemia, congestive heart failure, hypertension, chronic stable angina, etc.  

The following is how this is displayed in our EHR:

Knowing that your patient has a 20% chance of a cardiac event in the next 10 years sends a powerful message not only to the patient who is able to visualize this on the screen and then take a printed copy home, but it also helps break  "treatment inertia" and motivates the provider to modify these risks. The best  use of the application is that patients get involved in their health when they are able to translate the fact that they smoke, or have a high LDL, or low HDL into an actual risk of dying in the next 10 years.

I use these calculators to modify both my patients and my own behavior.  I encourage my colleagues to do the same and enter the 21st century of electronic patient management with the use of EHR. We can advance the health and wellness of our patients in incredible ways. Feel free to visit SETMA's website to see how we utilize these calculators.  You will find a tutorial for this tool at www.setma.com under "Electronic Patient Management Tools."  From that menu, click on "Framingham Cardiovascular Risk Assessment and select "Framingham Heart Study Risk Calculators." 

Alan E. Leifeste MD
Board Certified AAFP