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What is heart age?
Where is heart age used?
How does heart age fit into CVD risk management?
Does heart age improve risk communication?
Why do heart age calculators give different recommendations for the same patient?
Patient profile | Risk factors | NZ: HF website | UK: NHS website |
---|---|---|---|
Case 1 with elevated cholesterol but ‘ideal’ blood pressure would receive an older heart age estimate on both calculators, with two medications suggested for the lower result
| Age: 57 Sex: female Systolic BP: 120 Chol ratio: 5.6 BMI: 24 Smoking: no Diabetes: no | Older heart age (64) 5 yr. absolute risk = 4%
Mild risk below medication threshold
| Older heart age (60) 10 yr. absolute risk = 5%
May need chol & blood pressure medication
|
Case 2 with elevated blood pressure but lower than ‘ideal’ cholesterol would receive an older heart age on NZHF or the same heart age as current age on NHS, with one medication suggested for the lower result
| Age: 62 Sex: male Systolic BP: 130 Chol ratio: 3.5 BMI: 25 Smoking: no Diabetes: no | Older heart age (63) 5 yr. absolute risk = 7%
Mild risk below medication threshold
| Same heart age (62) 10 yr. absolute risk = 9%
May need blood pressure medication
|
Case 3 with obesity but ‘ideal’ blood pressure and cholesterol would receive a younger heart age on NZHF or an older heart age on NHS, with one medication suggested for the higher result
| Age: 48 Sex: female Systolic BP: 120 Chol ratio: 4 BMI: 38 Smoking: no Diabetes: no | Young heart age (< 48) 5 yr. absolute risk = 1%
Mild risk below medication threshold
| Older heart age (49) 10 yr. absolute risk = 2%
May need blood pressure medication
|
How does heart age relate to medication decision making?
• Practice variation: Heart age results may be younger, the same or older than current age for the same risk factors, depending on the CVD risk model and ideal risk factor thresholds used to calculate heart age; so it is important for doctors to understand the assumptions behind these calculators in order to avoid unwarranted practice variation. |
• Uninformed decision making: Patients cannot understand the chance of benefiting from preventive CVD medications such as statins and blood pressure lowering drugs without knowing the baseline absolute risk; so the relationship between heart age, absolute risk and recommended medication thresholds needs to be explained to enable informed decision making. |
• Over-treatment: Using heart age to decide on the need for drugs will lead to treatment of people who are very unlikely to experience a CVD event in the next 5-10 years; so treatment decisions should be made on the basis of absolute risk and not heart age. |
What could we use instead of heart age?
“When we offer statins, or any preventive treatment, we are practicing a new kind of medicine, very different to the doctor treating a head injury in A&E. We are less like doctors, and more like a life insurance sales team: offering occasional benefits, many years from now, in exchange for small ongoing costs. Patients differ in what they want to pay now, in side effects or inconvenience, and how much they care about abstract future benefits. Crucially, the benefits and disadvantages are so closely balanced that these individual differences really matter.” (Ben Goldacre, BMJ 2014) [10].