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High Risk Example
Read through the following 3 cases to see various ways you might use the risk assessment tool in different situations.
High Risk Case 3
Robert is a male patient aged 66 with 145/80 mm Hg blood pressure, total serum cholesterol of 7.3 mmol/L, HDL cholesterol of 1.1 mmol/L with no history of diabetes, smoking or family CVD. He has a BMI of 27.5 and doesn’t like the idea of any medical intervention.
Feedback
The risk is high (18%), so both blood pressure and cholesterol medication are recommended in the guidelines. Aspirin is not recommended for CVD prevention in Australian guidelines.
Some patients may be very anti-medication, as a general attitude or because of side-effects experienced in the past. In this case the risk calculator can be used to show how they can achieve similar changes to CVD risk with lifestyle changes to diet (e.g. following a Mediterranean diet) and physical activity (e.g. increasing the number of walks per week to meet national guidelines). Some GPs also use reluctance to take medication as a way to motivate lifestyle change. If the patient can reduce blood pressure for lifestyle over a short period, they may be able avoid medication. Or if they lose a lot of weight, they may be able to trial a period off medication.
He may not be willing to start any medication and I know even if I start, even if I give him the script he is not going to take it. I have to tell him look try all these changes, come back in 3 months…when he comes back and we see that the levels haven’t gone down, he would be more amenable to the idea of starting medication. Whereas if he had done it in the first instance, he may not have taken it.
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- Case studies
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Peer discussion
High Risk Case 3
Robert is a male patient aged 66 with 145/80 mm Hg blood pressure, total serum cholesterol of 7.3 mmol/L, HDL cholesterol of 1.1 mmol/L with no history of diabetes, smoking or family CVD. He has a BMI of 27.5 and doesn’t like the idea of any medical intervention.
Feedback
The risk is high (18%), so both blood pressure and cholesterol medication are recommended in the guidelines. Aspirin is not recommended for CVD prevention in Australian guidelines.
Some patients may be very anti-medication, as a general attitude or because of side-effects experienced in the past. In this case the risk calculator can be used to show how they can achieve similar changes to CVD risk with lifestyle changes to diet (e.g. following a Mediterranean diet) and physical activity (e.g. increasing the number of walks per week to meet national guidelines). Some GPs also use reluctance to take medication as a way to motivate lifestyle change. If the patient can reduce blood pressure for lifestyle over a short period, they may be able avoid medication. Or if they lose a lot of weight, they may be able to trial a period off medication.