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Sobre esta aplicación
Esta aplicación fue encargada al grupo GEDIC y a Pixeloide por la OPS, y está enteramente basada en el formulario que la Organización Mundial de la Salud propone para la estimación de riesgo cardiovascular en América Latina, zona denominada AMR-B (año 2007 - ISBN: 978 92435 4728 2). Este puntaje de riesgo surge de una adaptación a algunas particularidades de la región, sobre la base del estudio de Framingham.
Elección del idioma y de las unidades de colesterol y métricas
Seleccionando el ícono de rueda dentada se puede modificar el idioma (inglés ó castellano), las unidades de colesterol (mmol/l o mg/dl), y las unidades métricas (decimales en cm o sistema imperial en pies y pulgadas)
Cálculo inicial del riesgo individual
Su uso es sencillo. Introduciendo seis parámetros del individuo y seleccionando la opción calcular
se obtiene una estimación aproximada del riesgo de desarrollar enfermedades cardiovasculares
relevantes, tales como infarto de miocardio, angina de pecho, accidente cerebrovascular a 10
años.
Se considera riesgo bajo a una incidencia menor del 10% a 10 años, es decir, menos del 1% anual.
Otra forma de leerlo es considerar que de un grupo de 100 personas en esta situación, una
desarrollará una enfermedad cada año, alcanzando así 10 personas en una década. En el otro
extremo, riesgo muy alto mayor a 40% a 10 años, indica que de 100 personas en esa condición 4
tendrán eventos anualmente y 40 los tendrán en los próximos 10 años; casi uno de cada dos.
El calculador es más preciso si se conoce el nivel de colesterol en sangre, pero mantiene la opción
de no considerarlo si ese dato no está disponible.
Que pasaría si....
Una vez obtenida la estimación de riesgo, se puede evaluar en que medida el riesgo podría modificarse al corregir factores como el tabaquismo, la hipertensión arterial y la hipercolesterolemia. Se considera como ideal no fumar, valores de presión arterial menor a 140/90 mmHg y de colesterol total menor a 200 mg/dl. En algunos casos el colesterol deseable puede ser mucho más bajo que este valor de referencia, dependiendo de la presencia de otros factores de riesgo. De tal manera que el usuario puede notar que al dejar de fumar su riesgo baja a la mitad, o que se transforma de muy alto a bajo corrigiendo los tres factores que podemos influenciar en este calculador. La edad, el sexo no pueden ser modificadas, y la condición de diabetes se toma ante el conocimiento de su diagnóstico, pero no se basa en los niveles de glucemia ni otros parámetros.
Validación de esta aplicación
Se elaboró un algoritmo que remeda el uso de las clásicas tablas con colores. Se efectuaron validaciones en diferentes etapas. Con la versión actual, se elaboraron 100 casos al azar, y fueron clasificados por un grupo de médicos y técnicos en forma independiente, usando el calculador y las planillas. Luego se analizaron las discrepancias. En 100 casos se obtuvo una concordancia total, una vez corregidos un error al ingresar los datos en el calculador y cuatro errores de clasificación en la tabla de colores. Esto nos da la certeza de que el algoritmo copia exactamente el uso de las tablas clásicas, y facilita así la estimación de riesgo y los eventuales beneficios de su corrección. Aún así, agradeceremos si se detecta algún error evidente o inesperado nos sea notificado para su corrección.
Recomendaciones
Están basadas en las guías de prevención de la OPS y la OMS referidas. Incluyen consideraciones sobre el tratamiento antihipertensivo, el uso de estatinas, el manejo del tabaquismo, el ejercicio físico, aspectos dietéticos y otros.
Cálculo del Índice de masa corporal (IMC)
El IMC es un parámetro relevante pronóstico que no fue incluido clásicamente en estos calculadores. Hemos preferido facilitar su estimación, ingresando peso y altura, para luego compararlo con los parámetros aconsejables desarrollados en recomendaciones. Se considera un IMC normal cuando tiene valores de 19 a 24; sobrepeso de 25 a 29 y obesidad igual o mayor de 30.
Qué no incluye este calculador
Se ha evaluado una multiplicidad de factores de riesgo que no alcanzan en su relevancia a los seis considerados por el calculador, pero que pueden tener gran importancia. Entre ellos la obesidad, el sedentarismo, el estrés laboral y familiar, los antecedentes familiares de enfermedad coronaria o muerte de causa cardiovascular en edades tempranas (menos de 60 años). Ante la duda sobre si adoptar o no estrategias o terapéuticas preventivas, la presencia de uno o varios de estos factores nos inclinarán hacia una conducta más activa.
Alarma: recordatorio de medicamentos
Se ha incorporado un sistema sencillo para registrar los medicamentos que se están tomando, ingresando días de la semana y hora de la indicación, con la posibilidad de establecer alarmas que ayuden a evitar interrupciones u olvidos.
Precauciones en su uso
>Bajo ningún concepto este calculador está pensado como un reemplazo a la consulta médica o al juicio clínico. Su difusión ayudará a los médicos a estimar en forma rápida el riesgo cardiovascular, a dialogar con los pacientes para analizar en qué medida el riesgo puede ser modificado. Asimismo, intenta ayudar a personas inquietas por su salud, facilitando que puedan estimar la necesidad de una consulta médica cuando su riesgo no es bajo.
About this application
Pan American Health Organization commissioned GEDIC and Pixeloide Studios for the development of this application It is entirely based on the formula that the World Health Organization propose for estimating cardiovascular risk in Latin America, zone AMR-B. (2007 – ISBN: 978 92 4 154717 8). This risk assessment score takes into account various regional adaptations based on the findings of Framingham study.
Choice of language and of cholesterol an metric units
By selecting the gear icon you can change the language (English or Spanish), the units of cholesterol (mmol/l or mg/dl), and the metric units (decimal or imperial cm in feet and inches)
Initial calculation of individual risk
It is very easy to use. By entering in six different criteria about the individual and selecting the option “calculate,” the approximate risk of developing significant cardiovascular diseases in the next 10 years is calculated (myocardial infarction, angina pectoris, stroke).
It is considered low risk to show an incidence rate less than 10% in 10 years, or less than 1% a year. Another way to interpret these results is that 1 out of 100 people in this situation is at risk each year; 10 people in a decade. On the other extreme, very high risk would be more than 40% in the next 10 years, indicating that of 100 people, 4 will suffer from cardiovascular disease per year, and 40 will show signs in the next 10 years; almost 1 out of 2.
The calculator is more precise when cholesterol levels are introduced, however it allows for calculation without this number- if it is not available.
What would happen if...
Once the risk estimate is obtained, it evaluates different ways that it can be modified by correcting factors such as tobacco use, high blood pressure, and high cholesterol. It is considered ideal not to smoke, to have blood pressure lower than 140/90 and cholesterol levels under 200. Through this calculation, the users can see how quitting smoking lowers their risk by half, or that by changing any one of those 3 factors the estimated risk shifts from very high to very low, demonstrating how one can influence their outcome. Age and sex cannot be modified, and although diabetes is entered in as part of the analysis, it is not based on blood sugar levels or other criteria.
Validation of this application
We created an algorithm that replicates the use of the classic color charts. The validation process took place in different phases. For the current version, 100 random cases were independently compiled and classified independently by a group of doctors and technicians, using the calculator and the form. Next, the discrepancies were analyzed. Of the 100 cases, total concordance was found after correcting a typing error in the calculator and 4 classification errors in the color chart. This gives us the certainty that the algorithm reflects the exact use of the classic charts and facilitates the estimation of risk and the eventual benefits of making improvement. Nevertheless, we welcome any detection of unexpected errors.
Recommendations
Recommendations are based on the prevention guides provided by PAHO and WHO. They include considerations concerning hypertension treatments, the use of statins, managing tobacco use, exercise, diet, etc.
Body Mass Index (BMI) Calculation
The BMI is a relevant prognostic factor that was not initially included in these calculations. We prefer to facilitate the use of the BMI by entering in height and weight, so that later it can be compared to recommended criteria.
What the calculation doesn’t include
An array of risk factors were evaluated and excluded due to the lack of relevance compared to the 6 criteria used in the calculation; however these other factors may be very significant. Factors such as obesity, a sedentary lifestyle, work and family stress, family history of coronary heart disease or death due to cardiovascular causes at an early age (younger than 60 years). When in doubt about adopting strategies or preemptive interventions, the presence of one or more of these factors would indicate the need for more proactive behavior.
Alarm: Medication Remindes
We have included a simple system to register the medications the patient is using. Adding the days of the week and time of the indication, with the posibility of establishing alarms that will help the patient to avoid interumptions and/or oversights.
Precautions
Under no circumstance should this calculator be used as a replacement for a consultation with a doctor or a clinician’s judgment. We hope that the diffusion of this calculator will help doctors to quickly estimate cardiovascular risk, and discuss with patients in order to analyze ways the risks can be lowered through preventative measures. Another objective is to help people who are worried about their health to better estimate their need to consult with a doctor when their risk is not low.