Thresholds for Atherosclerotic Cardiovascular Disease Screening in Low-Resource Settings

ASCVD Testing in Low Resource Settings

Abstract

Background: Establishing appropriate thresholds for initiating cardiovascular and cerebrovascular disease (CVD) screening at a free medical service can be a challenging problem. With CVD remaining a leading cause of death and disability in the United States, atherosclerotic cardiovascular disease (ASCVD) screening is now a cornerstone of preventative primary care. Yet, limited financial resources, rotating (often volunteer) providers, and a lack of adequate insurance among patients who frequent free medical services can make wide-scale screening costly and even counter-productive.

Methods: This retrospective quality improvement project assessed CVD screening at the Worcester Evening Free Medical Service Program in Worcester, MA. Inclusion criteria consisted of acute or chronic medical encounters with patients ³ 18 years of age who were seen between January 1, 2010 and August 31, 2021. Data included patient demographics; social and economic status; hypertension, diabetes, and hypercholesteremia status; CVD risk stratification; and treatment.

Results: We found that we were consistently under-screening patients at risk for CVD.

Conclusions: Results were paired with a polysocial risk score (PsRS) created by Javed, Valero-Elizondo, Dudum et al. to propose an ASCVD screening algorithm appropriate for low-resourced settings. The algorithm recommends screening patients with: (1) A systolic blood pressure >139 mm/hg; or (2) A systolic blood pressure >120 mm/hg and one known CVD risk factor (diabetes, smoking, family history) or 3 or more social and economic factors associated with CVD risk.