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Physicians are not adequately following clinical practice guidelines on cardiovascular disease (CVD) prevention, citing poor usability and adaptability as key obstacles to implementation (Ref. 1). Furthermore, there are large differences across Europe regarding lifestyle and risk factor management (Ref. 2). Both of these shortcomings have serious implications on patient management and outcomes, thus the European Society of Cardiology (ESC) has been taking a serious look at how guidelines-based tools in CVD prevention can be made more applicable and user-friendly whilst both relevant and adaptable to the European clinical context.
The result of such discussions has been the development of HeartScore (Ref. 3), a new computer-based tool for CVD risk prediction and management, to be launched by the ESC on 2 April 2004.
A fully functional computer program, HeartScore offers significant advantages over former static risk chart formats, by providing physicians with a fully interactive piece of software that they can run from their PC and with which they can save patient records for future monitoring and comparison. Physicians can download HeartScore free of charge from the ESC web site, from 2 April 2004.
Professor Ian Graham, Chairman of the Joint European Societies Cardiovascular Prevention Committee, comments, "The major advantage of the HeartScore program over printed risk chart tables is its interactivity and adaptability. In using risk charts, one can only assess total risk, but with HeartScore it is possible to view changing risk. In other words, it is possible to see the difference in risk predictions with different target entries for blood pressure or cholesterol levels, or compare the risk prediction for a patient if he or she stops or continue smoking. The visual emphasis and usage of bar- and pie-charts is very effective and can also be shown to the patient directly to help get the message home".
HeartScore is based on the ESC's Systematic Coronary Risk Evaluation (SCORE) risk charts and Denmark's PRECARD risk assessment tool, using the latest European Guidelines on CVD Prevention (Ref. 4).
With data from 210,000 patients taken from 12 European cohort studies, SCORE is unique in terms of scale, size and international adaptability. Never before have so many populations been used in the formulation of a risk assessment tool. Previously, European risk charts were based on the Framingham Study with data from 5,000 people in the US. Although applicable to European populations with a higher risk, equivalent to that of the US, Framingham charts tend to overestimate risk in lower risk European populations such as France, Germany, Spain and Italy, countries with a lower incidence of CVD. Since it is not based on a single population, HeartScore will also be updatable as more population data becomes available and can also be recalibrated for specific countries based on their national mortality statistics.
Professor Graham states, "We are launching the high and low risk European versions of HeartScore in order to demonstrate the potential of these tools in the prevention and management of heart disease and stroke. It is our hope that National Cardiac Societies across Europe will embrace the potential of HeartScore on a national level and work with us to develop national versions for their populations".
HeartScore is a further demonstration of the ESC's mission 'to improve the quality of life of the European population by reducing the impact of cardiovascular disease". The ESC is thus committed to both the prevention and treatment of CVD, including ensuring that appropriate guidelines are formulated and adhered to in the clinical context.
Professor Bassand, ESC President, states, "Cardiovascular disease is the leading cause of death in Europe, and what's worse is that much cardiovascular disease can be prevented or at least delayed by improvements in lifestyle factors. People should be encouraged to minimise risk factors such as smoking, poor diet or insufficient exercise, both to reduce their chance of having heart problems and to increase their chance of survival after a heart attack or stroke".
Professor Bassand continues, "HeartScore is an excellent tool to help physicians better predict and discuss risk factors with their patients. We, the ESC, are confident that HeartScore will help both in the appropriate usage of prevention guidelines by physicians, but also in the communication of crucial prevention messages to the individuals with heart problems or at risk of developing them. We must all be encouraged to do our best to reduce our risk factors and increase our chances of leading a full, active and healthy life".
Notes to editors
The European Society of Cardiology (ESC) is a professional medical organisation comprising 47 National Cardiac Societies across central and greater Europe and more than 45,000 individual members.
The ESC Congress is held annually in late August/early September and is the largest medical meeting in Europe. The last ESC Congress was held in Vienna, Austria, in 2003 and received more than 25,000 attendees. The next ESC Congress will be held in Munich, Germany from 28 August to 1 September 2004. Press may register free of charge by contacting the Press Office on press@escardio.org for further details.
In parallel to the ESC Congress each year, the ESC stages 'For Your Heart's Sake', a public event on cardiovascular disease communication messages. Fun yet informative, 'For Your Heart's Sake' includes healthy eating tips, exercise demonstrations and cardiovascular disease risk assessment and counsel. The next 'For Your Heart's Sake' will be held in central Munich, Germany, from 30 August – 1 September 2004. 'For Your Heart's Sake', Munich, will conduct risk assessment using the newly adapted German version of HeartScore, currently in development.
The ESC is working closely with the Irish Department of Health and Children during the Irish Presidency of the European Union (EU) regarding the need for consensus across Europe regarding cardiovascular disease treatment and monitoring as well as the importance of continuity in data collection and analysis. The ESC dialogue with the EU was achieved following the ESC's formulation in 2002 of 'The Heart Plan for Europe', a document outlining the challenges and objectives for Europe in the reduction of cardiovascular disease. For more information on the ESC's work with the EU and 'The Heart Plan for Europe' see the press release section of the ESC Virtual Press Office, www.escardio.org/vpo or contact the ESC Press Office directly on press@escardio.org
As of 2 April 2004, the European version of the HeartScore program will be available to physicians for download, free of charge, from the ESC web site. The direct link will be www.escardio.org/HeartScore
References:
1. Market Research survey conducted for the European Society of Cardiology 2003.
2. EUROASPIRE Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II. Euro Heart Survey Programme. European Heart Journal 2001; 22:554-72.
3. HeartScore is a registered trademark of the European Society of Cardiology.
European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Executive summary: European Heart Journal 2003; 24(17): 1601-1610 and European Journal of Cardiovascular Prevention and Rehabilitation 2003; 10(4): S1-S11. Full text: European Journal of Cardiovascular Prevention and Rehabilitation 2003; 10 (Suppl 1): S1-S78.
HeartScore is a registered trademark of the European Society of Cardiology.
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