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Recipe Name: | Find patients eligible for My Health For Life with high CV Event risk |
Rationale: | My health for life will help people at high risk of developing chronic conditions such as heart disease, stroke and type 2 diabetes make healthy lifestyle changes. The steps in this recipe show how to identify patients meeting all or most of the eligibility criteria. Further information and resources are available here: https://www.myhealthforlife.com.au/ |
Target: | To identify all patients with no current diagnosis of diabetes, Heart Failure, CVD or chronic kidney disease who are eligible to be referred to the ‘My Health For Life’ program and are at high risk of a cardiovascular event in the next five years based on the absolute CV risk assessment. |
CAT Starting Point: |
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We provide other recipes showing how to find patients based on a single eligibility criteria on our My Health For Life recipe page here: My Health For Life Recipes
Warning |
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This recipe can be combined with the other recipes, for example you could use the recipe for patients with familial hypercholesterolaemia and then find who out of that group is at high risk of a CV event risk. |
CAT Start screen
RECIPE Steps Filters:
- In the Start Age box type 45 or 18 if looking for indigenous patients to show patients older than 45.
- If you want to search for indigenous patients older than 18 you will have to also apply the ‘Indigenous’ filter on the ‘Ethnicity’ tab. See here for full details: Ethnicity Filter
- OPTIONAL: In the "General" filter tab click on 'Active (3x in 2yrs)' - this will only show those patients with at least 3 visits in the last 2 years
- Click on "Conditions" tab under Diabetes select “No”
- Select "No" for Heart Failure
- Select “No” for all conditions listed under the CVD group
- Select “No” for “Chronic Renal Failure”
We have now created a filter to find patients older than 45 (or indigenous patients older than 18), with no diagnosis of diabetes, Heart Failure, CVD or chronic renal disease.
Adding Measures
Increased Waist Circumference
- Click on the ''Measures/Waist/CVD Risk'' tab and select the parts of the graph ''Greatly Increased'' that is M > 102cm,F > 88
To find patients at high risk of a CV event we will use the CV Event risk report in CAT4 - full details can be found here: CV (Cardiovascular) Event Risk CAT calculated
Limitations:
Warning |
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The CV Event risk report uses blood pressure and lipid results regardless of when the result was entered/taken. The most recent result will be used to calculate the risk. The reason behind this process is that a patient who was at high risk some time ago and doesn't have any recent results should be reviewed. |
CV Event Risk report
To find the patients at high risk of a CV event in the next five years, click on the CV Even Risk report tab and select the 16- >=30% ranges, then click on 'Export'
This will show a list of all patients at 16% or higher risk of a CV event in the next five years, with the selected demographic filter (45+ or indigenous and 18+) and with no diagnosis of heart disease, diabetes or chronic kidney disease.
Combining increased Waist Circumference and CV Event Risk
You will notice that both report tabs have a next to the report title. This indicates that you have selected one or more parts of a graph.
To combine the selections, click on the "Report" icon. For more information on cross-tabulation see our user guide here: Cross Tabulation Report
This will create a cross-tabulated report showing only those patients older than 45 (or indigenous patients older than 18) with no diabetes, Heart Failure, CVD or chronic renal disease and have increased waist circumference and high CV event risk in the last two years. In my example there are only 22 patients - these would be at high risk and benefit from being referred to the My Health for Life program as soon as possible.
Incomplete CV Event risk data
The second tab of the report shows the patients with missing data items:
Active patients with more than three visits should have most of the data items completed and this report will show if this is the case or not. No CV event risk can be calculated if the data is incomplete.