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Arnett et al 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Circulation. 2019;140:e596–e646. DOI: 10.1161/CIR.0000000000000678 September 10, 2019 e601 CLINICAL STATEMENTS AND GUIDELINES

1.6 Abbreviations

Abbreviation Meaning/Phrase ASCVD atherosclerotic cardiovascular disease AU Agatston units BMI body mass index BP blood pressure CHD coronary heart disease CKD chronic kidney disease CVD cardiovascular disease DASH Dietary Approaches to Stop Hypertension DBP diastolic blood pressure DM diabetes mellitus ENDS electronic nicotine delivery systems FDA US Food and Drug Administration GLP-1R glucagon-like peptide-1 receptor HbA1c hemoglobin A1c HDL-C high-density lipoprotein cholesterol HbA1c hemoglobin A1c LDL-C low-density lipoprotein cholesterol MI myocardial infarction PCE pooled cohort equations RCT randomized controlled trial SBP systolic blood pressure SGLT-2 sodium-glucose cotransporter 2 T2DM type 2 diabetes mellitus USPSTF US Preventive Services Task Force

2 OVERARCHING RECOMMENDATIONS

FOR ASCVD PREVENTION EFFORTS

2.1 Patient-Centered Approaches to

Comprehensive ASCVD Prevention

Recommendations for Patient-Centered Approaches to Comprehensive ASCVD Prevention Referenced studies that support recommendations are summarized in Online Data Supplements 1 and 2.

COR LOE Recommendations

I A 1.  A team-based care approach is recommended for the control of risk factors associated with ASCVD.S2.1-1–S2.1-14

I B-R 2.  Shared decision-making should guide discussions about the best strategies to reduce ASCVD risk.S2.1-15–S2.1-18

I B-NR 3.  Social determinants of health should inform optimal implementation of treatment recommendations for the prevention of ASCVD.S2.1-19–S2.1-25

Synopsis

This 2019 ACC/AHA Guideline on the Primary Prevention of CVD aims to promote the delivery of patient- centered care, which the writing committee felt was foundational to the guidance provided throughout. These patient-centered recommendations emphasize the importance of team-based care delivery, shared decision-making, and the evaluation of social determinants of health in ASCVD prevention efforts. These recommendations apply to all aspects of clinical practice for the primary prevention of ASCVD.

Recommendation-Specific Supportive Text

1 Team-based care makes use of multidisciplinary

health professionals to improve the quality and maintenance of ASCVD prevention. It is a multifaceted approach that supports clinical decisionmaking (ie, treatment algorithms), collaboration among different clinicians, and patient and family member participation to facilitate the treatment goals of patients.S2.1-26 RCTs and systematic reviews with meta-analyses demonstrated greater reduction of ASCVD risk with team-based care than with usual care in patients with hypertension, diabetes, and hyperlipidemia.S2.1-1–S2.1-14 A team-based approach to ASCVD prevention may result in significant improvements in patient outcomesS2.1-27 and often meets patient needs better than standard care, especially in low-resource settings and among vulnerable populations. In a team-based care model that compared patients enrolled in a preventive cardiology clinic staffed by advanced practice providers with a propensitymatched cohort of patients enrolled in primary care clinics, a reduction in cardiovascular risk was demonstrated through effective risk stratification and preventive management.S2.1-28 Other successful interventions that have used team-based care include telehealth monitoring, follow-up support aids, and patient education.S2.1-27

2 Decisions about primary prevention should be

collaborative between a clinician and a patient. Shared decision-making occurs when practitioners engage patients in discussions about personalized ASCVD risk estimates and their implications for the perceived benefits of preventive strategies, including lifestyle habits, goals, and medical therapies. Collaborative decisions are more likely to address potential barriers to treatment options, compared with treatment and guidance offered without patient input.S2.1-15–S2.1-18

3 Socioeconomic inequalities are strong determinants

of CVD risk internationally.S2.1-21,S2.1-24 Therefore, the clinician should tailor advice to a patient’s socioeconomic and educational status, as well as cultural, work, and home environments.S2.1-23 The Centers for Medicare & Medicaid Services has developed a

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