Claudette D. Johnson Grand Canyon University

1. CARDIAC RISK ASSESSMENT TOOL Claudette D. Johnson Grand Canyon University NUR: 645E Advanced Health Assessment for Nurse Educators January 30, 2013

2. Objectives • Identify and describe a health risk assessment tool • Conduct, analyze, and report results of a survey utilizing the tool • Analyze the tool based on validity, reliability and readability and appropriateness for the tool’s intended audience

3. Risk Assessment Tool: Framingham Description Reason for choice Widely used tool assisting in nationwide efforts to control the prevalence of heart disease and other diseases (Sheridan, Pignone & Mulrow, 2003) Used to identify interventions to help decrease cardiac diseases and death which meets the goals of the Million Hearts initiative, Healthy People 2020, and the American Heart Association 2020 (American Heart Association (AHA), 2012) Effective primary and secondary prevention could prevent or postpone as many as 56% of all deaths among people aged 30 to 84 years (Kottle, Jordan-Baechler & Parker, 2012) • Risk Assessment Tool for estimating 10-year risk of having a heart attack • This tool is designed for adults aged 20 years and older who do not have heart disease or diabetes (Sheridan, Pignone & Mulrow, 2003)

4. Framingham Tool Measures (Sheridan, Pignone & Mulrow, 2003)

5. Framingham Cardiac Risk Assessment Tool (Sheridan, Pignone & Mulrow, 2003).

6. (Sheridan, Pignone & Mulrow, 2003)

7. Survey Results

8. Survey Analysis • Equal comparison of data between men and women • Women <50 have lower risks for heart disease. • Scores are significantly lower due to smoking status (70% nonsmokers) • Total cholesterol levels greater than 200 added a greater number of points to the total score of these individuals when compared to other categories • HDL (“good” cholesterol) levels did not seem to affect the total scores by large amounts • For women, hypertension added larger points to the total scores than for men. • It is important to remember that the presence of any one of these risk factors may warrant further attention even if the 10-year risk dose not appear to be high(NHLBI, n.d.).

9. Readability Evaluation tool Flesch Reading Ease Scale Acceptable readability Easy to understand Responses to questions: simple responses, data known to users, response requiring yes or no responses Shortcoming: HDL and total cholesterol levels require testing Responses calculated by hand or calculator Result Flesch Reading Ease Scale • Uses average sentence and word length • Word difficulty measured by use of syllables per word • Syntactic measured by words per sentence • Score of 0-100 • Score of 0-40 indicates difficult to read • Score of 80-100 indicates easy to read • Norm: 60-70 words is acceptable readability (Stockmeyer, 2009; Ancker, 2004)

10. Appropriateness for Audience Evaluation tool Flesh-Kincaid Grade level scale score of 7. Indicates appropriateness for its intended users (ages 20 and up) Words used are direct and easy to understand Responses required are simple Result Flesch- Kincaid Grade Level Scale • Reflects the minimum grade level necessary to understand reading a document (Ancker, 2004) • Formula: reading grade level = (0.39 x average sentence length) + (11.8 x average syllables per word) -15.59, with college level reading equaling to Grade 16 (Ancker, 2004) • Stockmeyer (2009) suggests a grade level score of 7-8 as a norm. (Stockmeyer, 2009; Ancker, 2004)

11. Reliability • Predictor of 10 year coronary heart disease risk accuracy-95% and 83% • Predictor of 2 year coronary heart disease risk accuracy-67% and 98% • Men • Women • Ethnic Groups

12. Validity • Ethnic Populations -metabolic syndrome • Women -minority -elderly • Research mostly supports the tool’s validity • Some concerns were identified

13. Conclusion The Framingham risk assessment tool:

14. References American Heart Association (2012). Heart attack risk assessment. American Heart Association Organization. Retrieved from: http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart- Attack-Risk Assessment_UCM_303944_Article.jsp Ancker, J. (2004). Developing the informed consent form: A review of readability literature and an experiment. AMWA Journal. 19(3), 97-100. Batsis, J. & Lopez-Jimenez, F. (2010). Cardiovascular risk assessment: From individual risk prediction to estimation of global risk and change in risk in the population. BMC Medicine, 8, 29. Doi: 10.1186/1741-7015-8-29. Coke, L. (2010). Cardiac risk assessment of the older cardiovascular patient: The Framingham global risk assessment tools. MEDSURG Nursing. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_sp3.pdf. Gleeson, D. & Crabbe, D. (2009). Emerging concepts in cardiovascular disease risk assessment: Where do women fit in? Journal of the American Academy of Nurse Practitioners, 21, 480-487.Doi: 10.1111/1745-7599-2009-00434. Kottle, T., Jordan Baechler, C., Parker, E. (2012). Accuracy of heart disease prevalence estimated from claims data compared with an electronic health record. Preventing Chronic Disease. 9 (1). DOI: http://dx.doi.org/10.5888/pcd9.120009. Retrieved from: http://www.cdc.gov/pcd/issues/2012/12_0009.htm National Heart, Lung, Blood Institute (NHLBI) (n.d.) National cholesterol education program, third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). National Institutes of Health (NIH). Retrieved from: www.nhlbi.nih.gov/guidelines/cholesterol/index.htm Sheridan, S. Pignone, M. & Mulrow, C. (2003, December). Framingham-based tools to calculate the global risk of coronary heart disease: a systematic review of tools for clinicians. Journal of Internal Medicine. 18 (12). 1039-1052. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/14687264 Stockmeyer, N. (2009). Plain language. Michigan Bar Journal. 46-47.