A unified national cardiovascular disease (CVD) risk generator is required to address equity in the management of CVD risk in clinical practice in New Zealand

Abstract

There is a strong body of evidence that supports identifying and managing people according to their risk of a future cardiovascular (CVD) event. Since 2012 the New Zealand public health sector has achieved 90% CVD risk assessment (CVDRA) for each eligible person across New Zealand using a modified version of an overseas risk equation, through incentivising Primary Health Organisation (PHO) performance. In 2018 the New Zealand Ministry of Health endorsed the use of a suite of four new CVDRA equations which were developed using the large NZ Predict cohort (500,000 people). These equations more accurately reflect an individual's CVD risk and incorporate both traditional CVD risk factors, such as smoking and diabetes, but also sociodemographic factors including ethnicity and a deprivation score. The new CVDRA equations are an important tool to address the major inequities in CVD incidence, prevalence and mortality in Aotearoa-New Zealand. However, while the new equations provide more accurate assessment of risk, they are more complicated and therefore more prone to error if not properly validated and systematically implemented. To take advantage of this important opportunity to address equity in heart health we need strategic vision and national leadership. In this paper we make the case that to most safely and cost effectively implement the new equations, the Ministry of Health (MOH) should support a unified national CVD risk generator. A single, electronic, national CVD risk generator would: a) ensure national consistency and quality control-a single set of validated and current equations would be available to both clinicians and patients; b) avoid substantial replication of effort and cost in both developing and validating multiple calculators; c) enable central collection of the encrypted dataset required to develop more accurate risk assessment equations in population subgroups, both now and in the future, as CVD risk evolves; d) provide a platform to facilitate systematic and consistent national CVD risk communication and management; and e) facilitate ease of updating the tool and practice in the future as changes to the algorithm are agreed.