Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: protocol for an overview of systematic reviews

The use of screening tools for cardiovascular risk assessment in psoriasis – A case- control study

Background:

Psoriasis is a common, T-cell-mediated disease, affecting 0.44–2.8% of the general population in India. It is associated with a higher risk of cardiovascular disease possibly due to chronic inflammation. Those patients with severe psoriasis are at a higher risk of death due to cardiovascular disease. The use of scoring tools may help the care providers to assess cardiovascular risks in these patients.

Aims:

The aim of this study was to assess the cardiovascular risks in patients with severe psoriasis using the commonly used risk-assessment tools (Framingham risk score [FRS] and Pooled cohort equations [PCE]) and to understand the utility of these tools in practice.

Methods:

It is a case-control study performed in the dermatology outpatient department of a tertiary care center during the study period from January to December 2020. Consenting adults with chronic plaque psoriasis and psoriasis area and severity index (PASI) more than 10 were included in the study. The FRS and PCE risk scores were calculated for the patients and age- and sex-matched healthy controls.

Results:

A total of 213 patients were assessed and 30 patients were excluded. Of the 183 patients, 152 patients were assessed using FRS and 135 patients using PCE. Equal number of age- and sex-matched healthy controls were also assessed. The mean age of the patients assessed using the FRS and PCE was 47 ± 10.9 and 52.84 ± 8.9 years, respectively. The mean age of the controls was 45.52 ± 8.7 and 51.76 ± 8.1 years in the FRS and PCE groups, respectively. The male to female ratio was 1.92:1 and 2:1 in the FRS and PCE risk-score groups, respectively. The mean PASI score was 16.45 ± 7.88 and 15.6 ± 7.6 in the two groups, respectively. The 10-year risk estimate using FRS in the patients ranged from 0 to 26.9%. The mean and median estimates were 4.95 ± 5.7 and 2.8%, respectively, while 2.65 ± 4.7 and 0.8% in the controls (P = 0.001). The 10-year risk estimate in the patients using the PCE risk score ranged from 0.3 to 39.6%. The mean and median estimate in the patients was 8.17 ± 9.9 and 5.2%, respectively while they were 5.68 ± 7.5% and 2.6% in the controls (P = 0.024). The agreement between the FRS and PCE was found to be poor (Ϗ, 0.049). There was no statistically significant correlation of PASI to either the PCE risk score (P = 0.498) or FRS (P = 0.630).

Limitations:

A small sample size, and study in a tertiary care center may have resulted in sampling bias.

Conclusion:

Psoriasis is associated with a higher risk of cardiovascular disease. These tools may help a dermatologist in the primary prevention of cardiovascular disease. It can also help in the awareness of the increased risk of cardiovascular disease in patients.

Agreement between Framingham, IraPEN and non-laboratory WHO-EMR risk score calculators for cardiovascular risk prediction in a large Iranian population

Introduction: Estimation of the risk of cardiovascular diseases (CVD), may lead to prophylactic therapies. This study aims to compare and evaluate the agreement between CVD prediction of Iran Package of Essential Non-communicable Disease (IraPEN) and Framingham risk score (FRS).

Methods: All 40-79 years old participants in the Yazd Health Study who did not have a history of CVD were included. The 10-years risk of CVD was estimated by the laboratory (IraPEN), non-laboratory WHO-EMR B and FRS. The risk was classified into low, moderate and high-risk groups. Cohen’s weighted kappa statistics were used to assess agreement between tools. To assess discrepancies McNemar’s χ2 test for paired data was used. P values < 0.05 were considered statistically significant.

Results: In total, 2103 participant was included and the risk scores were calculated. Of them, 26.5% were stratified as high risk by FRS, compared with 6.1% by IraPEN. A slight agreement (37.9%) was observed (kappa 0.17, P < 0.0001), in other words. This discrepancy between IraPEN vs. FRS was seen in both sexes (P < 0.0001), although in women the agreement ratio was higher (52.1% vs. 21.3%). The discrepancy between FRS and IraPEN in categorizing people at risk of CVD was 55.5%, (P < 0.0001) but this was not significant between IraPEN and non-laboratory WHO-EMR-B (World Health Organization - Eastern Mediterranean Regional-B group countries) score (P < 0.523; discrepancies, 5.8%).

Conclusion: Our study shows a slight agreement between various CVD risk scores. Thus, reviewing the IraPEN and using alternative tools for the low-risk group should be considered by decision-makers. It is important to use a more reliable score for nation-wide risk assessment.

Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: an overview of systematic reviews

Background

Our objectives were to critically appraise and summarise the current evidence for the effectiveness of using cardiovascular disease (CVD) risk scoring (total risk assessment - TRA) in routine risk assessment in primary prevention of CVD compared with standard care with regards to patients outcomes, clinical risk factor levels, medication prescribing, and adverse effects.

Methods

We carried out an overview of existing systematic reviews (SRs). Presentation of the results aligned guidelines from the PRISMA statement. The data is presented as a narrative synthesis. We searched MEDLINE (Ovid), EMBASE, CENTRAL and SCOPUS databases from January 1990 to March 2017, reviewed the reference lists of all included SRs and searched for ongoing SRs in PROSPERO database. We encompassed SRs and meta-analyses which took into account RCTs, quasi-RCTs, and observational studies investigating the effect of using CVD risk scoring. Only studies performed in a primary care setting, with adult participants free of clinical CVD were eligible. Intervention was CVD risk assessment with use of the total CVD risk scoring compared with standard care with no use of TRA .

Results

We identified 2157 records, we then recognised and analysed 10 relevant SRs. One SR reported statistically insignificant reduction of CVD death, when using TRA, the second SR presented meta-analysis which reported no effect on fatal and non-fatal CV events compared with conventional care (5.4% vs 5.3%; RR 1.01, 95% CI 0.95 to 1.08; I² = 25%). Three SRs have shown that using TRA causes no adverse events. The impact of TRA on global CVD risk as well as individual risk factors is ambiguous, but a tendency towards slight reduction of blood pressure, total cholesterol and smoking levels, especially in high risk patient groups was observed. TRA had no influence on lifestyle behaviour.

Conclusions

There is limited evidence, of low overall quality, suggesting a possible lack of effectiveness of TRA in reducing CVD events and mortality, as well as a clinically insignificant influence on individual risk factor levels. Using TRA does not cause harm to patients.

Trial registration

Systematic review protocol was registered with the International PROSPERO database - registration number CRD42016046898.

Electronic supplementary material

The online version of this article (10.1186/s12872-018-0990-2) contains supplementary material, which is available to authorized users.

Effects of e-learning in a continuing education context on nursing care: a review of systematic qualitative, quantitative and mixed studies reviews (protocol)

INTRODUCTION

Continuing education (CE) is imperative to the future of professional nursing. The use of e-learning by registered nurses for CE is spreading. A review of systematic reviews will be conducted to develop a broad picture of the effects of e-learning in a CE context on nursing care.

METHODS AND ANALYSIS

Systematic qualitative, quantitative and mixed studies reviews published in English, French or Spanish from 1 January 2006 will be included. The outcomes of interest will be extracted and analysed inductively and deductively from the Nursing Care Performance Framework; some themes include nursing resources, nurses' practice environment, processes, professional satisfaction, and nursing sensitive outcomes. Three reviewers will independently screen first the title and abstract of the papers, and then the full texts in order to assess eligibility. Two teams of two reviewers will extract the selected reviews' characteristics and data. The results from various types of reviews will be integrated using a data-based convergent synthesis design. We will conduct a thematic synthesis and transform all quantitative and mixed data into qualitative data.

ETHICS AND DISSEMINATION

Ethics approval is not required for review of systematic reviews. We will summarise evidence concerning the negative, neutral and positive effects of various forms of e-learning on different aspects of nursing care. If we find gaps in the literature, we will highlight them and suggest ideas for further research. We will also focus on positive effects and present, if possible, the components and characteristics of e-learning interventions that were found to be successful. We will present this protocol and results in international conferences in nursing, medical, and health informatics domains. We will also submit the results of our work for peer-review publication in a journal indexed in the international bibliographic database of biomedical information.