Claudette D. JohnsonGrand Canyon University

NUR: 645E Advanced Health Assessment for Nurse Educators

January 30, 2013

CARDIAC RISK ASSESSMENT

TOOL

1. Identify and describe a health risk assessment tool

2. Conduct, analyze, and report results of a survey utilizing the tool

3. Analyze the tool based on validity, reliability and readability and appropriateness for the tool’s intended audience

Objectives

Description

Risk Assessment Tool for estimating 10-year risk of having a heart attack

This tool is designed for adults aged 20 years and older who do not have heart disease or diabetes

Reason for choice

Widely used tool assisting in nationwide efforts to control the prevalence of heart disease and other diseases (Sheridan, Pignone & Mulrow, 2003)

Used to identify interventions to help decrease cardiac diseases and death which meets the goals of the Million Hearts initiative, Healthy People 2020, and the American Heart Association 2020 (American Heart Association (AHA), 2012)

Effective primary and secondary prevention could prevent or postpone as many as 56% of all deaths among people aged 30 to 84 years (Kottle, Jordan-Baechler & Parker, 2012)

Risk Assessment Tool: Framingham

(Sheridan, Pignone & Mulrow, 2003)

Framingham Tool Measures

Increase risk of heart

attackAge

Gender

Total Cholesterol

HDL Cholesterol

Smoking

Systolic Blood

Pressure

(Sheridan, Pignone & Mulrow, 2003)

AGE

The older the

higher risk

TOTAL CHOLESTEROL

Borderline High

200- 239 mg/dl

High Greater than 240

mg/dl

HDLCHOLESTERO

L

Major risk< 40 mg/dL

Moderate risk 40-59 mg/dL

Low risk>60 mg/dL

SMOKERSmoked in last

month?

Yes

No

SYSTOLIC BLOOD

PRESSURE

Take top number of

reading

DIABETES

Yes

No

Framingham Cardiac Risk Assessment Tool

(Sheridan, Pignone & Mulrow, 2003).

(Sheridan, Pignone & Mulrow, 2003)

Survey Results

 53 y/o Male

25 y/o Male 41 y/o F 74 y/o F 25 y/o F 61 y/o M 69 y/o M 37 y/o F 78 y/o M 54 y/o F

Age 6 -9 0 14 -7 10 11 -3 13 6

Smoker 3 0 7 0 0 0 0 0 0 4

Total Cholesterol (335)=5 (155)=0 (131)=0 (210)=1 (169)=4 (242)=2 (193)=1 (178)=4 (105)=0 (175)=2

HDL Cholesterol (41)=1 (65)=-1 (38)=2 (76)=-1 (55)=0 (92)=1 (48)=1 (43)=1 (27)=2 (34)=2

Systolic BP/BP Meds

(124) (no)=1

(119)(no)=0

(125) (no)=1

(132) (no)=2

(126) (no)=1

(106) (yes)=0

(131) (yes)=2

(110) (no)=0

(160)(no)=3

(154) (yes)=5

Total: 16 -10 10 16 -2 11 15 2 18 19

                     

10 year Risk 25%Less than

1% 1% 4% 0% 8% 20%Less than

1%Equal to

>30% 8%

Equal comparison of data between men and women

Women <50 have lower risks for heart disease.

Scores are significantly lower due to smoking status (70% nonsmokers)

Total cholesterol levels greater than 200 added a greater number of points to the total score of these individuals when compared to other categories

HDL (“good” cholesterol) levels did not seem to affect the total scores by large amounts

Survey Analysis

For women, hypertension added larger points to the total scores than for men.

It is important to remember that the presence of any one of these risk factors may warrant further attention even if the 10-year risk dose not appear to be high(NHLBI, n.d.).

Flesch Reading Ease Scale Uses average sentence and word

length Word difficulty measured by use

of syllables per word Syntactic measured by words per

sentence Score of 0-100 Score of 0-40 indicates difficult to

read Score of 80-100 indicates easy to

read Norm: 60-70 words is acceptable

readability

Flesch Reading Ease Scale

Acceptable readability Easy to understand Responses to questions:

simple responses, data known to users, response requiring yes or no responses

Shortcoming: HDL and total cholesterol levels require testing

Responses calculated by hand or calculator

Readability

Evaluation tool Result

(Stockmeyer, 2009; Ancker, 2004)

Flesch- Kincaid Grade Level Scale Reflects the minimum grade level

necessary to understand reading a document (Ancker, 2004)

Formula: reading grade level = (0.39 x average sentence length) + (11.8 x average syllables per word) -15.59, with college level reading equaling to Grade 16 (Ancker, 2004)

Stockmeyer (2009) suggests a grade level score of 7-8 as a norm.

Flesh-Kincaid Grade level scale score of 7. Indicates appropriateness for

its intended users (ages 20 and up)

Words used are direct and easy to understand

Responses required are simple

Appropriateness for Audience

Evaluation tool Result

(Stockmeyer, 2009; Ancker, 2004)

Men Women Ethnic Groups

Predictor of 10 year coronary heart disease risk accuracy-95% and 83%

Predictor of 2 year coronary heart disease risk accuracy-67% and 98%

Reliability

Research mostly supports the tool’s validity

Some concerns were identified

Ethnic Populations-metabolic syndrome

Women-minority-elderly

Validity

Calculates one’s risk of the heart attack

Appropriately analyzes data from randomly selected individuals ages 20 and above and easily determines cardiovascular risk

Meets the standard readability

Found reliable as written in many literature and valid except for some concerns identified when testing certain ages, women,

and ethnic groups.

ConclusionThe Framingham risk assessment tool:

References

American Heart Association (2012). Heart attack risk assessment. American Heart Association Organization. Retrieved from: http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart- Attack-Risk Assessment_UCM_303944_Article.jspAncker, J. (2004). Developing the informed consent form: A review of readability literature and an experiment. AMWA Journal. 19(3), 97-100.Batsis, J. & Lopez-Jimenez, F. (2010). Cardiovascular risk assessment: From individual risk prediction to estimation of global risk

and change in risk in the population. BMC Medicine, 8, 29. Doi: 10.1186/1741-7015-8-29.Coke, L. (2010). Cardiac risk assessment of the older cardiovascular patient: The Framingham global risk assessment tools.

MEDSURG Nursing. Retrieved fromhttp://consultgerirn.org/uploads/File/trythis/try_this_sp3.pdf.

Gleeson, D. & Crabbe, D. (2009). Emerging concepts in cardiovascular disease risk assessment: Where do women fit in? Journal of the American Academy of Nurse Practitioners, 21, 480-487. Doi: 10.1111/1745-7599-2009-00434.

Kottle, T., Jordan Baechler, C., Parker, E. (2012). Accuracy of heart disease prevalence estimated from claims data compared with an electronic health record. Preventing Chronic Disease. 9 (1). DOI: http://dx.doi.org/10.5888/pcd9.120009. Retrieved from: http://www.cdc.gov/pcd/issues/2012/12_0009.htmNational Heart, Lung, Blood Institute (NHLBI) (n.d.) National cholesterol education program, third report of the expert panel on

detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Institutes of Health (NIH). Retrieved from: www.nhlbi.nih.gov/guidelines/cholesterol/index.htm

Sheridan, S. Pignone, M. & Mulrow, C. (2003, December). Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. Journal of Internal Medicine. 18 (12). 1039-1052. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/14687264Stockmeyer, N. (2009). Plain language. Michigan Bar Journal. 46-47.