Evidence-based Best Practice Guidelines
New Zealand
JUNE 2005
Cardiovascular Guidelines Handbook Developed for Primary Care Practitioners
CD Rom included
Risk Assessment Atrial Fibrillation Heart Disease Stroke Diabetes Smoking Cessation
Supported by Diabetes New Zealand
Evidence-based Best Practice Guidelines JUNE 2005
New Zealand
Cardiovascular
Guidelines Handbook Developed for Primary Care Practitioners
Risk Assessment Atrial Fibrillation Heart Disease Stroke Diabetes Smoking Cessation
Supported by Diabetes New Zealand
STATEMENT OF INTENT Evidence-based best practice guidelines are produced to help health practitioners, patients and consumers make shared decisions about health care choices in specific clinical circumstances. If properly developed, communicated and implemented, guidelines can improve care. While they represent a statement of best practice based on the latest available evidence (at the time of publishing), they are not intended to replace the health practitioner’s judgment in each individual case. Care decisions should consider the following: • the individual’s clinical state, age and comorbidities • personal preferences and preferences of family/whänau • current best practice based on the latest available research evidence. The clinical expertise (including skills and experience) of the practitioner is the key to integrating these elements to achieve the best possible outcome for an individual.
COPYRIGHT AND ADAPTATION OF THE GUIDELINE The New Zealand Guidelines Group, the National Heart Foundation of New Zealand and the Stroke Foundation of New Zealand encourage the free exchange of evidence in guidelines and promote the adaptation of the guidelines for local conditions. However, please note that guidelines are subject to copyright. If you wish to replicate or reproduce this guideline, in part or in full, please obtain agreement from the New Zealand Guidelines Group. The New Zealand Guidelines Group asks people wanting to reproduce guidelines to contact them. Access will not be unreasonably withheld. Where guidelines are modified for local circumstances, significant departures from these national guidelines should be fully documented and the reasons for the differences explicitly detailed.
©2005 New Zealand Guidelines Group PO Box 10 665, The Terrace, Wellington, New Zealand Phone: 64-4-471 4180 Facsimilie: 64-4-471 4185 E-mail:
[email protected] Website: www.nzgg.org.nz Published: June 2005 ISBN (Print): 0-476-01531-6 ISBN (Electronic): 0-476-01532-4
USING THIS HANDBOOK New Zealand Cardiovascular Guidelines Handbook: Developed for Primary Care Practitioners is a condensed version of the advice contained in six recent guidelines: • The Assessment and Management of Cardiovascular Risk • Management of Type 2 Diabetes • Life after Stroke: New Zealand Guideline for the Management of Stroke • The Management of People with Atrial Fibrillation and Flutter • Cardiac Rehabilitation • Guidelines for Smoking Cessation. These guidelines were produced by more than 90 representatives from health professional, Mäori, Pacific and consumer groups. A description of the guideline development processes and grading systems used by the guideline teams is contained in the full guidelines, which are available at www.nzgg.org.nz. This handbook is not intended to replace the health professional’s judgment in each individual case. It offers a practical reference for primary care practitioners. This is necessarily a brief synopsis of essential and hard-to-remember information. A complete description of management advice is contained in the full guidelines.
An electronic copy of the full guidelines this handbook is based on are available for download from www.nzgg.org.nz, or a printed copy is available from
[email protected], phone 64-4-471 4180 or write to PO Box 10 665, Wellington, New Zealand.
New Zealand Guidelines Group
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Figure 1: New Zealand cardiovascular risk charts
Risk level women NO DIABETES Non-smoker 4
5
6
7
8
4
DIABETES Non-smoker
Smoker
5
6
7
8
4
5
6
7
8
4
Smoker
5
6
7
8 180/105
180/105 160/95
AGE
160/95
140/85
70
140/85
Blood Pressure (mm Hg)
180/105
180/105 160/95
AGE
160/95
140/85
60
140/85
120/75
120/75
180/105
180/105
160/95
AGE
160/95
140/85
50
140/85
Blood Pressure (mm Hg)
120/75
120/75
120/75
120/75
180/105
180/105
160/95
AGE
160/95
140/85
40
140/85
120/75
120/75
4
5
6
7
8
4
5
6
7
8
Total Cholesterol:HDL ratio
4
5
6
7
8
4
5
6
7
8
Total Cholesterol:HDL ratio
Risk Level (for women and men) 5-year cardiovascular disease (CVD) risk (fatal and non-fatal) Very High
>30%
High
15–20%
25–30%
Moderate
10–15%
20–25%
5–10% Mild
2.5–5%
