Risk stratification and risk models in revascularisation

Summary

Health care systems have been developed with several goals in mind. Such goals include among others development of strategies for prevention of disease such as the provision of clean air, water, and adequate nutrition. Similar goals would include prevention of disease by emphasizing modification of identifiable risk factors in populations of patients such as implementation of no smoking guidelines and regulations or the development of “poly-pills’, the latter of which have been used in several country wide initiatives. A different non population based goal is centered on more personalized medicine whereby the universe of a single patient can be studied and strategies for improved outcome implemented. Quality of care metrics can be formulated for each of these goals. When developing personalized strategies, the results of randomized controlled studies are considered optimal. It is important to remember that the results of those trials related to and identify an average treatment effect which may not be applicable for the individual patient to be treated. To develop a personalized patient centric approach, data from the large randomized clinical trials can be used to test of validity and then identify individual predictive models with a good fit to achieve the desired goal.

These...