Doctors are calculating your heart attack risk incorrectly, and it could lead to more health care spending and unnecessary cholesterol-lowering drug prescriptions. Researchers from top universities put calculators using standardized algorithms to the test to see how accurately they could determine treatment, and published their findings in the journal Annals of Internal Medicine.

"Our results reveal a lack of predictive accuracy in risk calculators and highlight an urgent need to reexamine and fine-tune our existing risk assessment techniques," the study’s lead author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said in a press release. "The take-home message here is that as important as guidelines are, they are just a blueprint, a starting point for a conversation between patient and physician about the risks and benefits of different treatments or preventive strategies."

Researchers from Johns Hopkins, Columbia University, Northwestern University, University of California-Los Angeles, University of Minnesota, and Wake Forest University joined forces to study 7,000 men and women throughout the country between the ages of 45 to 84 each with varying ethnic backgrounds. None of the participants had preexisting cardiovascular disease. All participants were tested with five different calculators, and it turns out four of them managed to overestimate heart risk. The latest release of the clinical calculators was collaboratively designed by the American Heart Association and the American College of Cardiology in 2013.

"The less-than-ideal predictive accuracy of these calculators may be a manifestation of the changing face of heart disease," Blaha said. "Cardiac risk profiles have evolved in recent years with fewer people smoking, more people having early preventive treatment and fewer people having heart attacks or having them at an older age."

The clinical calculators were supposed to decide whether or not someone needed a daily dosage of aspirin, cholesterol-lowering drugs, or just watchful waiting with follow-up exams. They were based on a combination of factors, including gender, age, history of smoking, cholesterol levels, blood pressure, and diabetes. The research team concluded doctors are putting too much reliance on standardized algorithms and not enough importance on individualized risk assessment. Is the patient meeting daily physical activity requirements, what is their family history, and how is their diet on a long and short-term basis? The researchers want to analyze how different cardiovascular risk factors compare in their accuracy in order to assess the best approach for determining diagnosis.

"Additional testing could be a much-needed tiebreaker in the all-too-common 'to treat or not to treat' dilemmas," the study’s coauthor Dr. Roger Blumenthal, professor of medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said in a press release. "Such testing should be considered in all patients with marginal risk scores — those in whom the decision to treat with long-term statin and aspirin remains unclear."

Source: Blumenthal R. Blaha M, and DeFilippis AP, et al. Annals of Internal Medicine. 2015.