I've noticed a lot of people discussing the use of computer programs etc to
help the clinician estimate risks of heart disease and strokes in patients.
As I mentioned in a previous e-mail a couple of colleagues and I developed
a one page nomogram (using the Framingham data) which allows clinicians to
estimate absolute risks in 10-15 seconds for any patient. You can also
demonstrate visually to the patient the interplay between risk factors and
estimate the benefit of risk factor adjustment. You don't need a computer
or internet access to use this nomogram and you can give copies to you
patients. You can find this in Can Med Assoc J 1997;157:422-8. Any
comments on the utility of this would be appreciated.
I also noticed that Rod Jackson suggests that if you follow patients long
enough until everyone dies "then the NNT for death is 1 as everyone dies".
I may be wrong but if we did the ultimate clinical trial (where we followed
everyone until they were dead) the NNT would be infinite because if
everyone is dead no one benefits and the absolute difference is zero. We
should always be very clear with patients that we never PREVENT death we
only delay it. As far as I am aware, never in the history of the world have
we ever PREVENTED death. The same probably applies to coronary heart
disease - we likely do not prevent it long enogh to die from something else
we just DELAY it. Nonetheless, delays can clearly be clinically important.
Is this correct???? Any comments?
James McCormack, Pharm.D.
Associate Professor
Clinical Division Chair
Faculty of Pharmaceutical Sciences
c/o Pharmacy Department
St. Paul's Hospital
1081 Burrard St.
Vancouver, B.C.
Canada
V6Z 1Y6
604-631-5150 Fax 604-631-5154
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