U-Prevent knowledge base

Need some help? Here you will find the answers to questions you might have.

Patients
Can I also use the U-Prevent calculation tools as a patient?
The calculation tools are openly accessible to be used by anyone. We recommend, however, that you use U-Prevent together with your doctor. Your doctor can provide your personal health details that are needed to use the calculation tools and help you interpret the calculator’s output. The information generated by U-Prevent is not a substitute for professional medical advice or care provided by a qualified doctor or other health care professional.
What happens with my personal health details?
U-Prevent does not use your data for any other purpose then to calculate your cardiovascular risk and estimated effect of treatment. Your data will be erased at the end of each session. If you want to save your health profile and predictions, you may generate a printout of the results.
How precise are predications from U-Prevent?
The predicted risk and cardiovascular disease-free life-expectancy are averages for a group of people exactly the same as you. If there would be 100 or 1000 copies of you (i.e. same age, same blood pressure, same cholesterol level etc.), these estimates would be correct for that group. Of course, you as an individual member of that group could still have a different outcome due to unforeseen circumstances.
According to the lifetime calculator I will become very old; should I still care about gaining extra years?
The lifetime calculator estimates your life-expectancy without cardiovascular events. It is calculated as the average age at which someone with your exact health profile can expect to reach without having a myocardial infarction or stroke. This means that 50% of people like you (with exactly the same age, blood pressure, cholesterol level, etc.) will reach this age without experiencing a major cardiovascular event and the other 50% will not. Likewise, half of the potential life-years gained by medication treatment are lived in the years before this age. Notably, these extra years are years without cardiovascular events and, thus, in good health. The healthier you are right now, the more important it is to remain healthy.
Can all types of medication be prescribed by my doctor?
That depends on the local treatment guidelines and reimbursement criteria in your country. Your doctor will be able to explain this on request.
Healthcare providers
For what populations can I use the U-Prevent calculators?
U-Prevent offers calculators for the following adult patient groups: 1) apparently healthy people, 2) vascular patients, 3) type 2 diabetes patients, and 4) elderly. Please note that, in general, these calculators scores are not applicable to people diagnosed with any life-limiting diseases. Common examples of these life-limiting diseases include metastatic malignancy, advanced stages of kidney disease, heart failure, and pulmonary diseases. Caution is also advised when applying these scores to patients with certain monogenetic traits known to be associated with elevated (cardiovascular) disease risk, such as familial hypercholesterolemia.
Which calculator should I use?
We recommend that you follow the appropriate clinical practice guidelines in determining which tool to use. If you need guidance you may use our decision aid.
My patient already uses medication.
Why does the calculator not show the treatment gain of this current medication?
The effect of current medication is already reflected in current risk. This is because it affects current risk factor levels (e.g. blood pressure and cholesterol). U-Prevent predicts the effect of any changes compared to the current medication. To get an idea of the benefit of current medication, you could instead model the effect of stopping current medication.
Can I also estimate the effect of lifestyle changes with the U-Prevent calculators?
Lifestyle improvements such as smoking cessation, weight reduction, increased physical activity and a healthy diet are important and evidence-based first lines of cardiovascular preventive treatment. We recommend that lifestyle optimization should always be considered prior to initiating or intensifying medication. We have incorporated hazard ratios for smoking cessation in U-prevent that are based on large observational studies with high methodological quality (Arch Intern Med 2012; BMJ 2015). However, we were not able to obtain from the literature reliable and unbiased hazard ratios to estimate the independent effect of other lifestyle changes. For further reading on the effect of lifestyle on cardiovascular risk and mortality, we suggest the following articles on healthy diet(Circulation 1999; Am J Nutr 2010; NEJM 2013; BMC Med 2016), physical activity (Circulation 2011; Diabetes Care 2013) and obesity (Lancet 2011; JAMA Cardiol 2018).
How reliable are U-Prevent treatment effect predictions?
Please refer to the resources for healthcare providers for the scientific justification of the U-Prevent calculators. In short, U-Prevent combines externally validated prognostic models with randomized hazard ratios from trials.
When is individual treatment effect large enough to support treatment?
U-Prevent provides treatment effect predictions, but not recommendations. We advise following applicable treatment guidelines at all times.
Why do different scores provide different estimates of 10-year risk for the same patient?
It is not possible to tell with complete certainty whether a patient will have a cardiovascular event (100% risk) or not (0% risk). Thus, there is no one true estimate. Instead, the U-Prevent tools attempt to discriminate as well as possible. They have proven adequate accuracy in research datasets. Statistical and methodological differences between the tools may results in somewhat different estimates for an individual patient.
Why do the calculators not provide any measures of uncertainty?
The purpose of risk and treatment effect prediction is to support medical decision-making on the initiation or discontinuation of preventive interventions. The most optimal decisions are made based on the best-estimates of 10-year risk and cardiovascular-free life-expectancy (gain). Measures of uncertainty are not helpful in this respect.
Is treatment harm incorporated in U-Prevent treatment effect estimations?
No. Possible treatment harms include risk of side effects, financial costs and the disutility of taking pills on a daily basis. Although naturally important in decision-making on preventive treatments, the individual burden of treatment harm is difficult to predict. Also, the weight of these harms may be subjective.
How do I explain lifetime risk to my patient?
Lifetime risk is the chance of having a heart attack, stroke or dying from cardiovascular causes at some future point in your life.
How do I explain years gained without cardiovascular events to my patient?
This is the number of years without a myocardial infarction or stroke that can be earned by starting medication from today onwards. In a group of 100 or 1000 copies of your patient (i.e. same age, same blood pressure, same cholesterol level etc.), half of the extra years gained by medication treatment would be lived before the predicted survival age and the other half thereafter. Notably, these extra years are years without cardiovascular events and, thus, in good health. The healthier your patient is right now, the more important it is to remain healthy.
What if one or more risk factors are unavailable?
You may use the ‘NA’-button to impute missing information by the population mean/median value that was reported in the baseline table of the original risk score publication. Pragmatic imputation of missing values by the population median still results in reliable predictions provided important characteristics such as age are available (European Heart Journal ( 2018 ) 39 ( Supplement ), 291-292).
Why do I sometimes see a warning message on the results page?
The U-Prevent lifetime models estimate CVD-free life years based on the age at which survival probability is expected to drop below 50%. If this is not reached within the timeframe of the model, a different method of calculation is applied, based on the area under the survival curve. The latter method may lead to systematic underestimation of gain CVD-free life-years. When this warning message is shown, the results should be interpreted with caution. The estimates of 10-year risk and lifetime risk, however, are not susceptible to this statistical problem and may still be used.

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