Determining The Order In Which The Patients’ Files Will Be Reviewed

Ideally, the order in which the patient files should be reviewed should have the patient with the highest risk first and the one with the lowest risk last. Risk assessment has not reached such a fine degree of accuracy yet.
Nonetheless, a few generalizations regarding groups of patients can be made:

• Patients with documented cardiovascular disease are at highest risk.
• The risk in patients with diabetes often approaches that of patients with established coronary disease.
• LDL-cholesterol target levels are lower for high-risk patients. Many patients with CVD and/or diabetes are therefore considered dyslipidemic. Monitoring these patients includes modification of their lipid profile.
• Normalization of blood pressure requires more effort than normalization of the lipid profile, and is more likely to escape control in the short term.
• To date, the success rate for controlling hypertension and dyslipidemia is still higher than for smoking cessation.

Therefore, I recommend reviewing the patients’ files in the following order :

Patients with Documented CVD.
Patients with Diabetes – DM ---- (NO CVD).
Patients with Hypertension - HTN ---- (NO CVD; NO DM).
Patients with Dyslipidemia ---- (NO CVD; NO DM; NO HTN).
Smokers ---- (NO CVD; NO DM; NO HTN; NO DYSLIPIDEMIA).
All others.

By using this method for determining the order in which patients’ files should be reviewed, we come close to dealing with high-risk patients first. Still, it is important to understand that this is only an approximation. A patient with one risk factor of a severe degree could be at a higher risk than a patient with established coronary artery disease, whose risk factors are under control. As always, clinical judgment should take precedence.
(See DEMO).