Abstract 14114: Implementing Global Risk Assessment in Resource-Constrained Primary Care Settings: Kenya
Purpose: Global risk assessment (GRA) is recommended to quantify the risk for CVD and to guide prevention and treatment. Since most GRA tools require lipid measurements, implementing GRA in resource-constrained primary care settings has been difficult. Three non-laboratory based tools have been published: Gaziano (NHANES) and D’Agostino (Framingham) substitute BMI for lipid measures, while WHO excluded BMI or lipids in CVD risk calculation. The purpose of this study was to assess the feasibility of implementing non-laboratory-based GRA and to compare the 3 published tools in a resource-constrained primary care (PC) setting.
Methods: Community-based participatory research was conducted using sampled consecutive patients screened/treated for CVD risk factors at 5 community health clinics by trained US/Kenyan teams using protocols for physiologic/behavioral measures. GRA covariates include: age, gender, smoking, diabetes, SBP, antihypertensive Rx and BMI. Gaziano GRA was calculated with paper tool at the point-of-care; Framingham and WHO GRA were calculated from the screening dataset. Clinical data was abstracted and analyzed using Stata. US/Kenyan IRB approval was obtained.
Results: 941 individuals (mean age 48.6 ± 18.7, 78.6 % female, 100% black) were screened and reported: BMI 24.8 ± 4.9, SBP 137.6 ± 23.6, antihypertensive Rx (18.12%), hx of DM (6.89%), and smoking (6.29%). 50.3% had 2+ risk factors. GRA score of risk for developing CVD in 10 years: Gaziano, Framingham & WHO were: [low risk (56.3%; 55.8%, 94.5%), moderate risk (17.38%; 25.90%, 3.83%), high risk (26.3%; 18.2%, 1.62%)] respectively. Framingham and Gaziano were highly correlated (0.87; P<0.001); WHO had low correlation with Framingham & Gaziano (0.36; 0.33; P<0.001). Clinicians at the point-of-care were 80% accurate in calculating GRA.
Conclusion/Implications: Results indicate that GRA can be calculated in a resource-constrained PC setting using simple screening data and paper tools. Of note, the GRA estimates differed, however we do not know if Gaziano & Framingham tools overestimate or if WHO underestimates risk. Thus, despite implementation feasibility, research is needed to determine the best non-laboratory based GRA to use in Sub-Saharan Africa.
- © 2013 by American Heart Association, Inc.