‘We know what the average effect of blood pressure and cholesterol-lowering drugs is in average patients,’ says internist and professor of vascular medicine Frank Visseren of UMC Utrecht. ‘But the average patient does not exist. So not everyone benefits equally from the drugs. A shame if you take them unnecessarily for years. Or – much worse – if the right cholesterol or blood pressure treatment could have prevented a heart or brain attack.’
Until now, it was impossible for doctors to accurately estimate which preventive treatments would benefit an individual patient the most. That is why Frank Visseren and his colleagues developed U-Prevent, a website that makes a reliable statement about the individual treatment effect based on age, gender, blood pressure, cholesterol, kidney function, diabetes, vascular disease, and so on. The doctor or nurse enters this data with the patient.
U-Prevent then calculates the lifetime cardiovascular disease risk and the number of disease-free years added if you stop smoking, for example, and take cholesterol or blood pressure medications. Frank: “Patients watch the result on the screen. It’s very motivating when you see the graphs about your future health and the effects of lifestyle changes.’
Often the doctor provides a copy of the results so patients can read it again at home. They can also fill in the data themselves at home; for well-informed patients, the website is fine to use. Frank: “To prevent cardiovascular disease, a patient usually has to take medication for life. That is quite radical. You have to take a decision like that very carefully.’
Frank compares medication to a pension. ‘Nobody likes to pay a sum of money into the pension fund every month,’ he says. ‘But it’s an investment in your future. The same is true for blood pressure and cholesterol-lowering medications, at least for those at high risk. The earlier they start medication, the greater their chances of a healthy old age.’
Frank: ‘Thanks to U-Prevent we can better prescribe customized medication and sometimes even stop medication if it appears to have little effect. A patient can participate in the decision-making process by indicating what a treatment should yield in terms of extra cardiovascular disease-free life. That leads to a completely different conversation with patients in the consulting room.’
U-Prevent has been in use since August 2018 mainly by general practitioners, cardiologists and internists. ‘About 500 to 600 unique visitors a day use the U-Prevent website,’ says Frank. ‘We see a strong upward trend.’ The website was recently included in the Dutch cardiovascular risk management guideline and has also been embraced by the European Cardiology Association. ‘Not surprising,’ says Frank. ‘Because with U-Prevent as decision support, physicians deliver better and more efficient care.’
In order to create the website, cooperation was established with many universities at home and abroad and hundreds of thousands of anonymous patient data were collected. Different algorithms were developed for different groups of patients.
Meanwhile, there is a 2.0 version. Frank: ‘In this version it is possible to also make a calculation if some patient data is missing. The website then calculates the probable value itself. Very handy.’ Version 3.0 is in the works. Frank: ‘In this version we link the website to the electronic patient file, so that data is loaded automatically. The doctor or nurse then no longer has to enter anything manually. The calculation tool is getting smarter all the time.’
How exactly does U-Prevent work? The animation below explains it.
