As already noted, the problem of control of blood pressure and the correction of concomitant risk factors in the case of patients without clinical manifestations of atherosclerosis is that patients are not motivated for drug treatment (“risk factors do not hurt”), not to mention the motivation for non-pharmacological methods for the correction of concomitant risk factors. In this regard, one should note the successful experience of holding educational schools (in Ivanovo, Khabarovsk), which indicate that achieving better control not only of blood pressure, but also of correcting risk factors is quite possible .
Of particular note is the relevance of the development and implementation of motivational technologies in clinical practice. One of them can be the electronic version of SCORE (Systematic Coronary Risk Evaluation – Systematic (regular) coronary risk assessment) – a new system for assessing the risk of fatal outcomes of CVD for 10 years, developed by experts of the European Society of Cardiology together with specialists of the Federal Research Center The Ministry of Health and Social Development of Russia based on data from prospective studies conducted in European populations, including Russian (in total, more than 200,000 people). This The interactive system allows you to visually demonstrate to the patient the risk of a fatal outcome from CVD within 10 years and its positive dynamics in reducing the risk as a result of the intervention. Such a visual computer demonstration is designed to increase the motivation and commitment of patients to the drug and non-drug correction of risk factors and, ultimately, lead to a significant decrease in MDR. Currently, the Russian version of HeartScore has appeared on the Internet, which can be used by practical doctors.
The SCORE system includes the following risk factors: gender, age, smoking, systolic blood pressure (MAP), total cholesterol level. The high-risk criterion was defined as a risk of 5% and higher, in contrast to the previous figure of 20% and higher.
The status of smoking is determined when the patient is asked if he answers “yes” or “no”. A patient is considered to be a smoker if he smokes more than seven cigarettes a week.
The risk is considered very high if, when the patient data is projected onto the SCORE card, it is higher than 10%; high – if it is in the range from 5 to 10% medium – from 2 to 4% and low – less than or equal to 1%.
In case of high and very high risk, the patient needs to take active preventive and therapeutic measures aimed at eliminating and correcting risk factors.
Compared to the risk table, the advantages of using HeartScore for clinicians and patients are in their speed and ease of use, individual adaptation to the patient. The program offers:
. – graphic demonstration of absolute cardiovascular risk,
. – assessment of the relative role of corrected risk factors,
. – recommendations of intervention that contributes to a change in the behavior of treatment tolerance, i.e. patient adherence to treatment. HeartScore ® is a primary prevention tool for CVD, for assessing the risk of those who are not yet sick. But patients with existing symptoms of diseases associated with atherosclerosis require intensive treatment to prevent complications, so in such cases there is no need to resort to such a risk assessment, because these patients are already at high risk. HeartScore ®helps to assess the risk, and does not pretend to the absolute accuracy of the forecast. In HeartScore task ® It does not include an influence on the decision of the doctor regarding the tactics of treatment of patients and the starting point of treatment (from what level of risk to start treatment). These questions undoubtedly remain in the competence of the doctor.
In accordance with the European recommendations for the prevention of CVD, treatment should begin if the risk of death from CVD within 10 years exceeds 5%. For young patients, it is necessary to focus on the relative risk table. We have conducted a multicenter large-scale study on the effectiveness of integration into the clinical practice of the electronic version of SCORE. . The study involved 350 therapists from 47 cities of Russia. Each therapist included 3 high-risk patients with hypertension in the study (risk on the SCORE scale> 5%). A total of 1050 patients were included in the program. For the first time in the practice of research, not only in Europe, but also in Russia, the electronic version of SCORE was used to study the effect of its use in order to increase adherence to medical treatment of hypertension and effective control of associated risk factors. For this purpose, a subsample of 128 patients with AH was formed. In these patients, the risk was assessed using the electronic version of SCORE. Patients (n = 481 people) matched for age, sex, systolic blood pressure, frequency of smokers, body mass index were selected as the control group.In the control group, patients were shown a risk assessment according to the usual SCORE table. All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. And / or decrease in DBP not less than 10 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.compared with the group of patients in whom the total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.compared with the group of patients in whom the total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.
These data indicate the feasibility of introducing into clinical practice the management of patients without clinical manifestations of atherosclerosis of the electronic version of SCORE, not only as a tool for assessing the overall risk, but also as a motivational technology to improve adherence to drug and non-drug risk control methods. Ultimately, this should lead to a more effective reduction in total cardiovascular risk.