Incorporating Lab Values in Cardiovascular Risk Assessment

September 22, 2015

incorporating lab values in cardiovascular

risk assessment

Today’s lab leaders are actively seeking opportunities to elevate the value of their labs. They are employing new strategies and creating new initiatives. They are expanding their focus and strategic approaches. They are beginning to redefine what the lab can offer on a higher level than ever before.

While many of these opportunities need to be uncovered strategically, others are waiting in plain sight. In fact, some apply to entire categories at large. By helping create efficiencies in these spaces, savvy lab leaders are in an extraordinary position to make a massive, positive impact on their organizations’ bottom lines.

For an example of such an opportunity, look to the disease that is the leading cause of mortality worldwide—CVD.1 Not only does CVD cause one death every 40 seconds in the U.S.,2 but its prevalence is expected to grow by nearly 10% over the next two decades. By 2030, a staggering 40.5% of Americans are projected to have some form of CVD.3


A big way to take leadership to heart

How does the prevalence of CVD affect the lab? As the scope of CVD rises dramatically, so do the incidence and cost of lab testing. This, however, does not necessarily translate to higher quality care. It usually translates to an excess of data and spending on a grand scale. It contributes to CVD being the most expensive disease to treat in the nation, at 17% of overall medical costs.3

Laboratory tests, such as those for CVD, are being ordered across specialties without need for a variety of reasons.

According to a 2014 national survey of 600 physicians:4

  • Nearly 75% say the average physician prescribes an unnecessary test or procedure at least once a week
  • Fifty-two percent cite "concern about malpractice issues" as a major reason for excessive testing, while 36% cite "just to be safe" and 30% cite "wanting more information for reassurance"
  • Nearly 75% say unnecessary tests and procedures represent a serious problem in the healthcare system

leading change starts with leading knowledge

Patient risk stratification has incredible potential to cut out wasteful testing. By placing focus on key risk factors, it can help highlight what data would be most valuable to obtain. Physicians, however, are limited in their ability to do this. Deeper knowledge is needed to more effectively assess risk.

Through their particular knowledge of tests for CVD biomarkers, laboratorians can uniquely elevate risk stratification and inform evidence-based policies. This illuminates a significant, untapped opportunity to create efficiencies in cardiovascular care.

These examples point to the power of biomarker tests:

In decompensated heart failure risk assessment:

  • NT-proBNP levels can help predict future complications and therefore hospital readmission5

In ACS risk assessment:

  • Troponin T, CRP, and NT-proBNP can help predict 30-day mortality6

In cardiovascular risk assessment:

  • Markers of myocardial strain, myocardial cell damage, inflammation and vascular damage, atherosclerosis, and renal function can provide a multifaceted stratification approach7

With exclusive knowledge of biomarker tests, laboratorians have the ability to pinpoint cardiac disease risk and illuminate precisely when further CVD testing is needed.

Laboratorian-informed risk assessment

Increases

Decreases

Test utilization

Resource allocation

Cost management

Therapeutic decision-making

Quality of care

Unnecessary testing

Data overload

Excessive spending

Ineffective use of laboratory
resources and personnel

With the rising incidence of CVD, consider how aiding in key testing decisions would help you add value to your organization.

building a foundation of leadership

Beyond improving bottom-line value, sharing your knowledge to improve practices puts you in a prime position to develop pivotal partnerships with cardiologists.

In the same 2014 national survey of 600 physicians from above, 2 out of 3 feel a great responsibility to ensure their patients avoid unnecessary tests and procedures. Furthermore, 85% say that having specific, evidence-based recommendations to use with patients would be effective.4

These statistics don’t lie—they point to an incredible need for your knowledge and collaboration. Now is the time to rise to the challenge and make yourself invaluable across hospital disciplines. This sets the stage for further developmental initiatives organization-wide, in your ongoing effort to lead your lab forward.

References: 1. World Health Organization. (2014). The top 10 causes of death (Fact sheet No 310). 1211 Geneva 27, Switzerland. Retrieved from http://www.who.int/mediacentre/factsheets/fs310/en/. 2. American Heart Association Statistics Committee & Stroke Statistics Subcommittee, (2015). Heart disease and stroke statistics – At-a-glance. American Heart Association. Retrieved from http://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf. 3. Heidenreich, P.A., Trogdon, J.G., Khavjou, O.A., Butler, J., Dracup, K., Ezekowitz, M.D., Finkelstein, E.A., Hong, Y., Johnston, S.C., Khera, A., Lloyd-Jones, D.M., Nelson, S.A., Nichol, G., Orenstein, D., Wilson, P.W.F., Woo, J. (2011). Collision course: America’s baby boomers and cardiovascular disease. My American Heart, p. 2. Retrieved from http://www.my.americanheart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_322081.pdf. 4. PerryUndem Research/Communication (2014). Unnecessary tests and procedures in the health care system, What physicians say about the problem, the causes, and the solutions. The ABIM Foundation. Retrieved from http://www.choosingwisely.org/wp-content/uploads/2014/04/042814_Final-Choosing-Wisely-Survey-Report.pdf. 5. Bettencourt, P., Azevedo, A., Pimenta, J., Friões, F., Ferreira, S., Ferreira, A. N-Terminal-Pro-Brain Matriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients. Circulation. 2004;110:2168-2174. 6. Sabatine, M.S., Morrow, D.A., de Lemos, J.A., Gibson, C.M., Murphy, S.A., Rifai, N., McCabe, C., Antman, E.M., Cannon, C.P., Braunwald, E. Multimarker Approach to Risk Stratification in Non-ST Elevation Acute Coronary Syndromes. Circulation. 2002;105:1760-1763. 7. Daniels, L.B, Maisel A.S. Multiple marker approach to risk stratification in Stable CAD. EurHeartJournal. 336,10.1093.

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