The recent dispute over the accuracy of a cardiovascular risk calculator has its roots in differing data sets and the lack of a blueprint over how to develop health guidelines for widespread consumer use.
November’s dispute over the accuracy of the cardiovascular risk calculator, unveiled with great fanfare at the annual meeting of the American Heart Association, highlights both the power and limitations of “big data” in healthcare, according to a story published this month in Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care.
The cardiovascular risk calculator, developed by a joint committee of the American College of Cardiology and the American Heart Association, has generally received good reviews for its emphasis on preventing stroke and heart disease. But the points of contention were serious enough that the uproar landed on the front page of The New York Times just as the new guidelines were being launched.
What’s at issue? Critics of the calculator say it vastly overestimates the number of people who should be taking statins, in large measure because the tool relies too heavily on a person’s age. Evidence-Based Diabetes Management explores how the use of different data sets by the calculator’s creators and a pair of Harvard researchers who questioned its accuracy fueled the controversy. Defenders say critics are relying on news reports, not the guidelines themselves. For the full story, http://www.ajmc.com/publications/evidence-based-diabetes-management/2014/Jan-Feb2014/Understanding-the-Role-of-Big-Data-in-the-CV-Risk-Calculator-Controversy.
Questions about the risk calculator and other aspects of the guidelines have sparked a separate debate, one that concerns how guidelines designed for widespread consumer use are created in the first place. Some observers of the flap over the ACC/AHA guidelines told EBDM that the mere existence of the dispute shows that the committee failed to take sufficient steps to ensure widespread acceptance.
“Every time a controversy plays out like this, it hurts patients. Many people will leap from the assertion that this calculator recommends statins too frequently to the conclusion that they should always refuse to use statins,” Steven Nissen, MD, of the Cleveland Clinic told EBDM.
The lack of an accepted blueprint for developing consumer health guidelines is part of the problem. A member of the ACC/AHA guidelines committee said that Institute of Medicine is trying to address that issue. “They were talking about guideline writing committees that had designed good processes,” said David Lloyd-Jones, MD, ScM, of Northwestern University.
