This post was authored by John A. Spertus, MD, MPH, FACC, presenter at the 2016 Cardiovascular Summit.

The practice of cardiology is immensely challenging. On the one hand, we have more evidence to guide treatments than any other area of medicine. On the other hand, however, our clinical trials summarize the benefits of treatments over an entire population of patients. When treating an individual patient, how are we to know whether they will benefit from one therapeutic approach vs. another? How much will they benefit and are the benefits worth the costs? As providers are increasingly going to be help accountable for being responsible stewards of societal resources, while also maximizing the outcomes of our patients, we need new approaches to tailor treatment to risks.

One particularly exciting – and evolving – strategy is the use of precision medicine. While precision medicine is often considered to reflect the use of genetics or biomarkers to predict treatment benefits, these are only variables in a multivariable risk model. For example, one would clearly treat a 74-year-old vasculopath with advanced kidney injury much differently than a 42-year-old with no comorbidities at all, even if they had the same genetic risk factor. Thus, while we await the generation of new risk models that incorporate genetic and biomarker variables, we can begin by using clinical risk models to better extrapolate evidence to individual patients.

The ACC’s NCDR has been a leader in the creation of risk models. While primarily used to risk-adjust outcomes for quality improvement, these same models can be used to tailor treatment to risk and improve outcomes. A recent publication showed that the use of the NCDR percutaneous coronary intervention (PCI) bleeding risk model, when given to interventionalists prior to PCI, was associated with a 44 percent reduction in bleeding events while lowering the use of bivalirudin in low-risk patients, as compared with the rest of NCDR hospitals without access to patients’ bleeding risks. These low-risk patients are unlikely to benefit from treatment and hospitals can save money by using heparin ± a radial approach.

As our profession prepares for the tectonic shifts in reimbursement that are coming from the Centers for Medicare and Medicaid Services, we need to re-engineer health care delivery to improve outcomes while lowering costs. Leveraging the extraordinary data resources of NCDR to build evidence-based prediction models that can improve care is an exciting strategy. Figuring out how to implement these risk models, encourage use of precision medicine to target care and continually improving the consistency of aggressively treating patients who most benefit is a critical opportunity for our field.

This post is part of a series of posts from the 2016 Cardiovascular Summit: Solutions for Thriving in a Time of Change, taking place Feb. 18 – 20 in Las Vegas, NV. Stay tuned to the ACC in Touch Blog for additional perspectives and recaps from the meeting.

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