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Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.

ABSTRACT:

SUBMITTER: Tobe SW

PROVIDER: S-EPMC4234715 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.

Tobe Sheldon W SW Stone James A JA Walker Kimberly M KM Anderson Todd T Bhattacharyya Onil O Cheng Alice Y Y AY Gregoire Jean J Gubitz Gord G L'Abbé Mary M Lau David C W DC Leiter Lawrence A LA Oh Paul P Padwal Raj R Poirier Luc L Selby Peter P Tremblay Mark M Ward Richard A RA Hua Diane D Liu Peter P PP

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20141020 17

PMID: 25332362

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Project description:ImportanceThe 2017 American College of Cardiology/American Heart Association hypertension guideline recommends lower blood pressure (BP) thresholds for initiating antihypertensive medication and treatment goals than the 2014 evidence-based hypertension guideline.ObjectiveTo estimate the potential association of the 2017 and 2014 hypertension guidelines with the proportion of US adults defined as being hypertensive or recommended for antihypertensive treatment and with risk reduction of major cardiovascular disease (CVD) and all-cause mortality.Design, setting, and participantsUsing data from the National Health and Nutrition Examination Survey 2013 to 2016, we estimated the proportions of US adults with hypertension or recommended for antihypertensive treatment according to the 2017 and 2014 hypertension guidelines. Using data from the National Health and Nutrition Examination Survey, antihypertensive clinical trials, and population-based cohort studies, we estimated risk reductions of CVD and all-cause mortality assuming the entire US adult population achieved guideline-recommended systolic BP (SBP) treatment goals. Data were analyzed between October 2017 and March 2018.Main outcomes and measuresProportions and numbers of individuals with hypertension or recommended for antihypertensive treatment and numbers of CVD and all-cause mortality reduction.ResultsAccording to the 2017 hypertension guideline, the prevalence of hypertension (BP level ≥130/80 mm Hg) was 45.4% (95% CI, 43.9%-46.9%), representing 105.3 (95% CI, 101.9-108.8) million US adults, which was significantly higher than estimates per the 2014 hypertension guideline (BP level ≥140/90 mm Hg): 32.0% (95% CI, 30.3%-33.6%) or 74.1 (95% CI, 70.3-77.9) million individuals, respectively. Additionally, the proportion of individuals recommended for antihypertensive treatment was significantly higher according to the 2017 hypertension guideline (35.9%; 95% CI, 34.2%-37.5%) compared with the 2014 hypertension guideline (31.1%; 95% CI, 29.6%-32.7%). Achieving the 2017 hypertension guideline SBP treatment goals is estimated to reduce 610 000 (95% CI, 496 000-734 000) CVD events and 334 000 (95% CI, 245 000-434 000) total deaths in US adults 40 years and older. Corresponding estimates after achieving the 2014 hypertension guideline SBP treatment goals were 270 000 (95% CI, 202 000-349 000) and 177 000 (95% CI, 123 000-241 000), respectively. Implementing the 2017 hypertension guideline is estimated to increase 62 000 hypotension and 79 000 acute kidney injury or failure events.Conclusions and relevanceCompared with the 2014 hypertension guideline, the 2017 hypertension guideline was associated with an increase in the proportion of adults recommended for antihypertensive treatment and a further reduction in major CVD events and all-cause mortality, but a possible increase in the number of adverse events in the United States.

Project description:IntroductionThe most common cause of hospital emergency department visits is trauma resulting from a variety of underlying mechanisms. Unknown neck and spinal cord injuries and a lack of early diagnosis can have catastrophic consequences, such as paralysis of some or all limbs. The use of imaging techniques reduces the number of patients suffering from severe injuries.ObjectiveTo assess and compare the effectiveness and ease of utilizing two different sets of guidelines, the National Emergency X-Radiography Utilization Study guidelines (NEXUS) and the Canadian C-Spine guidelines (CCR), on trauma patients.MethodsThis study was approved by the Ethics Committee of Tabriz University of Medical Sciences. Of all the patients presenting to the hospital, 200 trauma patients were randomly included in the study. NEXUS and CCR were surveyed for each patient, and subsequent radiographies were also requested. The specificity and sensitivity of each of the methods was calculated, and the two methods were compared using Kendall's W test.ResultsA total of 200 trauma patients who met the inclusion criteria were included in the study. A total of 69.5% of the patients were male, and 30.5% were female. According to NEXUS guidelines, 47.5% of the patients were required to undergo neck radiography. According to CCR guidelines, 57.5% of the patients were required to undergo neck radiography. The sensitivity was found to be 90% for neck radiography by both NEXUS and CCR guidelines, while specificities were found to be 54.73% and 44.2% for NEXUS and CCR guidelines, respectively.ConclusionThis study showed that the two guidelines have the same sensitivity for evaluating which trauma patients need to undergo radiography. It seems that the NEXUS guidelines have the same effectiveness as CCR for determining which trauma patients need to undergo radiography. They also perform better than CCR guidelines in terms of ruling out which cases need no further radiologic investigation.

Dataset Information

Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.

Publications

Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.

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