Which patients should be the highest priority for intensive preventive management in primary care?
Patients with prior cardiovascular disease (CVD) had a 20% higher absolute risk of having another CVD event at 5 years compared with those who had no prior CVD, based on a large study of primary care patients conducted by A.J. Kerr, MD, University of Auckland, New Zealand, and colleagues, and published in Heart. Based on this finding, the authors indicate that patients with prior CVD “should be the highest priority for preventive management in primary care.” The authors state that dichotomizing primary and secondary prevention separates patients with and without prior CVD, and that these patients would be better served by conceptualizing CVD as a spectrum of disease with a unified approach. CVD risk assessments were generated between 2002 and 2007 using a Web-based Framingham risk prediction algorithm (ie, PREDICT-CVD) in routine primary care. Individualized risk profiles were then linked to national hospitalization and death records. Observed and predicted risk, according to the Frami
