US 6,322,504 B1Grant
Computerized interactive method and system for determining a risk of developing a disease and the consequences of developing the disease
Issue Date:2001-11-27
•15 Claims
•74 Drawing Sheets
Abstract
An interactive computerized method and system for determining the risk of developing a disease, consequences of the disease, providing ways of modifying the risk, and tracking the progress of an individual as his or her risk factors change or remain the same. The method includes:
transmitting questions to the individual pertaining to risk factors for the disease via a processor;
receiving responses to the questions from the individual via the processor;
transmitting contemporaneous feedback to the responses via the processor;
determining the risk of the individual developing the disease or the associated consequences of having the disease using at least one of the responses and practice guidelines for the disease;
transmitting a summary of positive risk factors and risk modification information to the individual via the processor; and
tracking changes in the responses and the positive risk factors of the individual over time.
The system includes a processor executing a program that performs the method.
Metadata
Assignee
- R and T, LLC
Inventor
- Ronald Kirshner
Application Information
Application Number:US 09/535,689
Filing Date:2000-03-27
Priority Date:2000-03-27
Art Unit:7
Classifications
IPC:
A61B 500
Field of Search:
707104
Patent Drawings (74 sheets)
Description
FIELD OF THE INVENTION
[0009] The present invention relates to a method and a system for determining a risk of developing a disease and the consequences of having the disease, in particular, an interactive computerized method and system for determining the risk of developing coronary artery disease and the consequences of having the disease.
BACKGROUND INFORMATION
[0010] Coronary artery disease (CAD) is the leading cause of death for Americans today. Approximately twenty percent (20%) of all American deaths are due to CAD. It is estimated that sixteen (16) million Americans per year are treated for CAD, and one million of these will suffer a heart attack.
[0011] Risk factor modification (RFM) and preventive medicine are becoming a major trend as it relates to modifying an individual's risk of developing a disease. For example, RFM for CAD encompasses many aspects of daily life such as smoking cessation, obesity reduction, exercise, lipid management, dietary modification and supplementation, and taking an aspirin a day. Individuals have recognized the importance of a healthy lifestyle. Indeed, physicians are under increasing pressure from the government, medical specialty organizations, managed care and patients to practice preventive medicine. Moreover, managed care and insurance companies have recognized that RFM is a very cost effective strategy. Unfortunately studies show that little progress has been made in the area of RFM and preventive medicine—especially with regard to cardiovascular health.
[0012] Practice guidelines have been developed and/or published by the American College of Cardiology and American Heart Association, the U.S. Department of Health and Human Services Agency for Healthcare Policy and Research (AHCPR), and the National Heart, Lung and Blood Institute. These guidelines provide algorithms for risk assessment and modification. The practice guidelines, however, are cumbersome, difficult to use, and not readily accessible to or understood by patients. Thus, there is a need to bring RFM to the forefront and simplify the information provided in the practice guidelines.
[0013] The Internet and world wide web (WWW) have become major factors in providing healthcare information and resources. Web sites such as, WebMD.com, Medscape.com, Dr.Koop.com, Realage.com and cardassoc.com, provide both physicians and users with valuable healthcare information. These web sites can be categorized into one of four types:
[0014] 1. Informational,
[0015] 2. E-mail,
[0016] 3. Questionnaire, and
[0017] 4. Combinational.
[0018] Informational type web sites typically provide encyclopedia-like healthcare information. Informational web sites, however, are generally difficult to navigate because they provide an individual with huge amounts of information, which must be sifted through. E-mail type web sites allow a user to type in questions that are answered by physicians at a host site. The users, however, are only provided with cursory answers to their questions. Questionnaire type web sites typically ask the user a series of questions to assess the user's health. None of these web sites provide the user with contemporaneous feedback regarding risk factors for a particular disease based on the information that is provided by the user. Finally, none of these web sites track the user's progress as his or her health status improves or deteriorates. Thus, it would be useful to provide an interactive web site that allows a user to provide detailed information regarding a disease, determines an individual's risk of developing the disease, determines the risks associated with the disease if the individual already has the disease, provides ways in which the individual can decrease his or her risk of developing the disease, and tracks the individual's progress with respect to modification of his or her risk factors.
SUMMARY OF THE INVENTION
[0019] The interactive computerized method and system according to the present invention determines an individual's risk of developing a disease, for example CAD, or the individual's risk associated with the disease if the individual already has the disease, and provides RFM information to the user. The method and system according to the present invention also tracks the individual's progress in modifying his or her risk factors. The computerized method and system is implemented via a computer operating either in a stand alone mode or in any conventional networking environment, such as the Internet, WWW or local area network (LAN). The computer accesses a program that implements the method according to the present invention. The program may be accessed by a user, for example, an individual providing his own information or another's information.
[0020] The program may be written in a conventional programming language, such as C++ or hypertext markup language. The program determines the individual's risk of developing the disease and provides ways for the individual to modify his or her risk.
[0021] The program implements several sections. One section determines the individual's risk for developing the disease. The user accesses this section of the program via a login routine. After logging in, the user is asked a series of questions regarding known risk factors for the disease, for example physical characteristics, lifestyle information and medical history. As the user answers the question, the user is advised if the user's response is a positive or negative risk factor with respect to the disease. Based on the information provided by the user, statistical models about risk significant events and practice guidelines for the disease, the individual's risk for developing that disease is determined, or if the individual already has the disease, the associated consequences of having the disease are determined.
[0022] Another section of the program deals with RFM. Once the individual's risk is assessed, the user is provided a summary of the individual's risk factors and may learn about ways for the individual to modify his or her risk of developing the disease.
[0023] A third section of the program is accessed on a user's subsequent visits to the program. In this section, the user's current responses are compared to the user's previous responses to provide feedback to the user and to monitor the individual's progress.
[0024] The information provided by individual's accessing the program may be used, for example, in future studies.
[0025] In the example embodiment, CAD is the disease for which the risk is determined and RFM is provided.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] FIG. 1 illustrates a system in which a method according to the present invention may be implemented.
[0027] FIG. 2 illustrates a flow chart for a program for executing a method according to the present invention.
[0028] FIG. 3 illustrates a flow chart for the login section shown in FIG. 2.
[0029] FIG. 3A illustrates an example embodiment of a screen display of the login section shown in FIG. 3.
[0030] FIG. 3B illustrates an example embodiment of a screen display for registration of first-time user of the program shown in FIG. 2.
[0031] FIG. 4 illustrates a flow chart of the preliminary assessment of chest pain section shown in FIG. 2.
[0032] FIG. 4A illustrates a screen display of a first portion of the preliminary assessment of chest pain section.
[0033] FIG. 4B illustrates a screen display of a second portion of the preliminary assessment of chest pain section.
[0034] FIG. 5A illustrates a first section of a flow chart for the risk factor collection section shown in FIG. 2.
[0035] FIG. 5B illustrates a second section of a flow chart for the risk factor collection section shown in FIG. 2.
[0036] FIG. 5C illustrates a third section of a flow chart for the risk factor collection section shown in FIG. 2.
[0037] FIG. 5D illustrates a fourth section of a flow chart for the risk factor collection section shown in FIG. 2.
[0038] FIG. 5E illustrates a fifth section of a flow chart for the risk factor collection section shown in FIG. 2.
[0039] FIG. 5F shows an example embodiment of an opening screen display for the risk factor collection section or risk factor modification section modification section shown in FIG. 2.
[0040] FIG. 5G shows an example embodiment of a screen display for the collection of an individual's physical characteristics.
[0041] FIG. 5H shows an example embodiment of a first screen display for the collection of an individual's lifestyle information.
[0042] FIG. 5I shows an example embodiment of a second screen display for the collection of an individual's lifestyle information.
[0043] FIG. 6A illustrates an example embodiment of a screen display of a personal risk factor summary.
[0044] FIG. 6B illustrates various advisor screens indicating a positive risk factor.
[0045] FIG. 6C illustrates a screen display of information regarding smoking as a risk factor.
[0046] FIG. 6D illustrates a screen display of information regarding dyslipidemia as a risk factor.
[0047] FIG. 6E illustrates a screen display of information regarding hypertension as a risk factor.
[0048] FIG. 6F illustrates a screen display of information regarding left ventricular hypertrophy as a risk factor.
[0049] FIG. 6G illustrates a screen display of information regarding the non-use of aspirin as a risk factor.
[0050] FIG. 6H illustrates a screen display of information regarding diabetes as a risk factor.
[0051] FIG. 6I illustrates a screen display of information regarding obesity as a risk factor.
[0052] FIG. 6J illustrates a first screen display of information regarding lack of physical activity as a risk factor.
[0053] FIG. 6K illustrates a second screen display of information regarding lack of physical activity as a risk factor.
[0054] FIG. 6L illustrates a screen display of information regarding hormone replacement therapy as a risk factor.
[0055] FIG. 6M illustrates a screen display of information regarding anger and stress as a risk factor.
[0056] FIG. 6N illustrates a screen display of information regarding levels of lipoprotein as a risk factor.
[0057] FIG. 6O illustrates a screen display of information regarding levels of homocysteine as a risk factor.
[0058] FIG. 6P illustrates a screen display of information regarding non-use of antioxidant vitamins as a risk factor.
[0059] FIG. 6Q illustrates a screen display of information regarding alcohol consumption as a risk factor.
[0060] FIG. 6R illustrates a screen display of information regarding age as a risk factor.
[0061] FIG. 6S illustrates a screen display of information regarding family history as a risk factor.
[0062] FIG. 6T illustrates a first screen display of information regarding known coronary artery disease as a risk factor, and a second screen display of information regarding known vascular disease as a risk factor.
[0063] FIG. 7A illustrates a first section of a flowchart for the calculation of risk section shown in FIG. 2.
[0064] FIG. 7B illustrates a second section of a flowchart for the calculation of risk section shown in FIG. 2.
[0065] FIG. 7C illustrates a third section of a flowchart for the calculation of risk section shown in FIG. 2.
[0066] FIG. 7D illustrates a fourth section of a flowchart for the calculation of risk section shown in FIG. 2.
[0067] FIG. 7E illustrates a fifth section of a flowchart for the calculation of risk section, shown in FIG. 2, for a male.
[0068] FIG. 7F illustrates a fifth section of a flowchart for the calculation of risk section, shown in FIG. 2, for a female.
[0069] FIG. 8 illustrates a flow chart for the probability diagnosis section shown in FIG. 2.
[0070] FIG. 8A illustrates a flow chart for determining the quality of a chest pain.
[0071] FIG. 8B illustrates a flow chart for determining the location of a chest pain.
[0072] FIG. 8C illustrates a flow chart for determining the duration of a chest pain.
[0073] FIG. 8D illustrates a flow chart for determining what provokes a chest pain.
[0074] FIG. 8E illustrates a flow chart for determining what provides pain relief for a chest pain.
[0075] FIG. 8F illustrates a flow chart for determining the stability of angina.
[0076] FIG. 8G illustrates a flow chart for determining the risk that the angina is CAD.
[0077] FIG. 8H illustrates a flow chart for determining the risk that angina is CAD for an individual that smokes and has diabetes and hyperlipidemia.
[0078] FIG. 9 illustrates a flow chart for the doctor section shown in FIG. 2.
[0079] FIG. 10 illustrates a flow chart for the course of action section shown in FIG. 2.
[0080] FIG. 11 illustrates a flow chart for the risk factor modification (RFM) section shown in FIG. 2.
[0081] FIG. 12 illustrates a flow chart for the 911 section shown in FIG. 2.
DETAILED DESCRIPTION
System Overview
[0082] FIG. 1 illustrates a system in which a method according to the present invention may be implemented. The system illustrated is implemented as an Internet application; however, the present invention is compatible with any type of information network, public or private. Thus, the present invention may be implemented using a private Intranet, local area network (LAN), metropolitan area network (MAN), wide area network (WAN) or even a wireless network. The present invention may even be implemented in a stand alone mode.
[0083] The example system shown in FIG. 1 includes a user computer system, such as a personal computer system 101, and a server computer system 103. The personal computer includes a central processing unit (CPU) including memory and storage, input devices, and output devices. The CPU runs a conventional operating system, such as Microsoft Windows 2000, 1998 or NT, and a web browser such as Microsoft Internet Explorer or Netscape. The input devices include, for example, a keyboard, mouse, touch-screen, floppy drive and/or CD-ROM drive. The output devices include, for example, a monitor and/or printer.
[0084] The server computer system 103, like the personal computer system, includes a CPU, input devices, and output devices. The server computer system also includes memory and storage devices 104, which store, for example, databases. The server computer system 103 runs an operating system and a program implementing a method according to the present invention. The personal computer system 101 and the server computer system 103 communicate via a communications link 102, such as, a modem, T1 line or POTS line, the Internet, and a T1 line.
Overall System Flowchart
[0085] FIG. 2 illustrates a flow chart of a program for executing a method according to the present invention. In the example embodiment, the program determines the risk of developing CAD and ways to modify the risk of developing CAD. It should be noted that this program may be implemented for any disease for which there are known risk factors and practice guidelines. Once the program is accessed via the Internet, e.g., by a user using a browser, a login section, which is described in detail below (FIG. 3), is executed (step 300). The login section determines whether a user is a first time user, a registered follow-up user, or a doctor whose patient is a user that completed a probability of diagnosis section 800. If the user is a first time user (step 201), a preliminary assessment of chest pain section 400, which is described in detail below (FIG. 4), is executed. If the user is a registered follow-up user (step 202), the follow-up user is queried whether there has been a significant change in his or her symptoms since the last time the user accessed the program (step 203). If there has been a significant change in the follow-up user's symptoms, then the preliminary assessment of chest pain section 400 (FIG. 4) is executed. If there has not been a significant change in the follow-up user's symptoms, then the risk factor collection section 500 (FIGS. 5A-5E), which is described in detail below, is executed. If the user is a doctor whose patient has completed probability of diagnosis section 800 (FIG. 8), then doctor's section 900, which is described in detail below (FIG. 9), is executed.
[0086] Preliminary assessment of chest pain section 400, described in detail below (FIG. 4), assesses a user's experience with chest pain. If preliminary assessment of chest pain section 400 determines that an existing chest pain is acute (step 204), then 911 section 1200, which is described in detail below, is executed (see FIG. 3). If preliminary assessment of chest pain section 400 determines that there is no chest pain or the chest pain is not acute, and the user wants to learn about risk factor modification (RFM) (step 205), then risk factor collection section 500, which is described in detail below (FIG. 5), is executed. If the user does not want to learn about RFM, the user is invited to return and the program is ended.
[0087] Risk factor collection section 500 collects information on the user's physical characteristics, lifestyle and medical history. After risk factor collection section 500 is performed, risk factor summary section 600 is executed. The risk factor summary section 600 provides the user with a personal list of risk factors for developing CAD. If it is determined in risk factor collection section 500 that the user had recent coronary artery disease (CAD) (steps 206, 208), then the user is advised to see a physician (step 210) and queried if the user would like to learn about RFM (step 216). If the user wants to learn about RFM (step 216), a RFM section 1100, which is described in detail below (FIG. 11), is executed. If the user does not want to learn about RFM, the program is exited and the user is invited to return.
[0088] If risk factor collection section 500 determines that the user does not suffer from CAD and chest pain (steps 206, 207), then the user's risk of developing CAD is calculated in section 700. If risk factor collection section 500 determines that the user had a CAD event that was not recent (step 206, 208) and the user would like to discuss the chest pain (step 209), then probability of diagnosis section 800, which is described in detail below (FIG. 8), is executed. If the user has had a CAD recent event (step 208) and does not want to discuss his chest pain (step 209, then step 216 is executed as discussed above.
[0089] Probability of diagnosis section 800 determines whether the user chest pain is, for example, noncardiac, atypical angina, or typical angina. Probability of diagnosis section 800 also determines whether the angina is stable and the risk that the chest pain will lead to a heart attack and/or is CAD. If probability of diagnosis section 800 determines that the user is experiencing angina now or has a high or intermediate risk of having a heart attack (step 211), then 911 section 1200 is executed. If probability of diagnosis section 800 determines that there is a high or intermediate risk that the angina is CAD (step 212), then doctor's section 900 is executed. If the doctored wants a stress test (step 213), then doctor's section 900 is executed. If the user has CAD, the program proceeds to step 216 and continues as described above. If the user does not have a high or intermediate risk of having a heart attack (step 211), a high or intermediate risk that the angina will develop into CAD (step 212), and CAD (step 213), then risk calculation section 700 is executed. After the user's risk of developing CAD is calculated, the program executes step 216 and continues as described above.
[0090] In the doctor's section 900 information about left ventricular ejection fraction, stress imaging test results, exercise tolerance tests, and pattern of the CAD. After doctor's section 900, the user may either calculate his or her risk of developing CAD(700), view his or her course of action 1000, determine his or her probability of diagnosis 800, view the RFM section 1100, or exit the program. If the user has no chest pain and wants to view his or her risk of developing CAD (step 215), then risk calculation section 700 is executed. After risk calculation section 700, the program proceeds to step 216 and the program continues as described above. If the user wants to view his or her course of action (step 217), then course of action section 1000 is executed. After course of action section 1000, the program proceeds to step 216 and the program continues as described above. If the user wants to determine his or her probability of diagnosis (step 218), then probability of diagnosis section 800 is executed. After probability of diagnosis section 800, the program proceeds to step 211 and the program continues as described above. If the user wants to view the RFM section (step 216), then RFM section 1100 is executed. If the user wants to exit (step 216), then the user is invited to return and the program is ended.
[0091] After RFM section 1100, if the user chest pain is not CAD (219), the user is invited to return and the program is exited. If the user has CAD that could be coronary (step 219), then the user is queried whether the user would like to determine the probability of diagnosis (step 220). If the user would like to determine the probability of diagnosis, then probability of diagnosis section 800 is executed followed by step 211. If the user does not want to determine the user's probability of diagnosis (step 220), then the user is queried whether he would like to visit the doctor's section 900. If the user would like to visit the doctor's section (step 221), then doctor's section 900 is executed followed by step 215). If the user does not want to visit the doctor's section, then the user is invited to return and the program is exited.
Login Section
[0092] FIG. 3 illustrates a flow chart for the login section shown in FIG. 2. The login section is executed when a user accesses the program. The user is instructed to either register as a new user or login (step 301). If the user is a follow-up user (step 302), for example, the user provides a userid and password, which are authenticated by the system (step 306). After step 306, if the follow-up user is resuming a session (step 312), then the program goes to the part of the program where the follow-up user exited the previous time (step 313). If the follow-up user is not resuming a session, then the login section is exited to the program as shown in FIG. 2.
[0093] If it is determined that the user is a first time user (step 302), then the new user is instructed to select a userid, password and password question and answer (step 303). The password question and answer are used when a user attempts to login but cannot remember his or her password. It is used to remind the user of his or her password. If the userid matches an existing userid or information is missing or invalid (step 304), then the new user is instructed to choose a different userid, supply missing information, and/or correct the invalid information (step 305). Once the new user has selected a userid that does not match an existing userid and/or provided valid information, then the new user is prompted to enter his or her gender, race (optionally), birth date, occupation and zip code (step 310). Next, the new user is instructed to remember his or her userid and password (step 311) and the login section is exited to the program.
[0094] FIG. 3A illustrates an example embodiment of a screen display for a portion of the login section. If the user is a first time user, the user is prompted to register first (302). Otherwise, the user is prompted to enter his or her userid (306a), password (306b), and either resume the previous session (313) or begin a follow-up session (314).
[0095] FIG. 3B illustrates an example embodiment of a screen display for an account registration portion of the login section. The first-time user is prompted to enter a userid and password (303a-b), confirm the password (303c), and enter a password question (303d). The first-time user is also prompted to enter his or her sex (310a), date of birth (310b), race (310c), occupation (310d), and zip code (310e).
Preliminary Assessment of Chest Pain Section
[0096] FIG. 4 illustrates a flow chart for the preliminary assessment of chest pain section shown in FIG. 2. The questions asked in the flow chart are just one example of the questions that may be asked to assess the user's chest pain. The user is queried if the user has ever had chest pain (step 401). If the user has had chest pain, the user is queried as to whether could be coronary (step 402). If so, the user is queried whether the user is experiencing chest pain now (step 403). If the user has never had chest pain (step 401), has had chest pain but it was not coronary (step 402), or has had coronary chest pain but not now (step 403), then the preliminary assessment of chest pain section is exited.
[0097] If the user is having chest pain now that could be coronary, then another series of question's are asked (step 404-408). If the chest pain is the user's first chest pain (step 404), then the chest pain is classified as acute (step 409) and the preliminary assessment of chest pain section is exited to the program. If the chest pain is not the user's first chest pain (step 404), but the chest pain is more prolonged than usual, then the preliminary assessment of chest pain section proceeds to step 409 as described above. If the chest pain is not the user's first chest pain (step 404), the chest pain is not more prolonged than usual (step 406), and the user does not have a protocol, then the preliminary assessment of chest pain section proceeds to step 409 as described above. If the chest pain is not the user's first chest pain (step 404), the chest pain is not more prolonged than usual (step 406), the user has a protocol that did not work (steps 407-408), then the preliminary assessment of chest pain section proceeds to step 409 as described above. If, however, the chest pain is not the user's first chest pain (step 404), the chest pain is not more prolonged than usual (step 406), the user has a protocol that worked (steps 407-408), then the preliminary assessment of chest pain section is exited to the program.
[0098] FIG. 4A illustrates an example embodiment of a screen display of a first portion of the preliminary assessment of chest pain section. FIG. 4A shows the user's response to the questions queried in steps 401-402 (whether the user has ever had coronary chest pain or CAD). FIG. 4A also shows step 205 querying the user whether the user would like to learn about RFM.
[0099] FIG. 4B illustrates an example embodiment of a screen display of a second portion of the preliminary assessment of chest pain section. FIG. 4B shows the user's responses to the questions queried in steps 401-404, 406-408. FIG. 4B also shows step 205 querying the user whether the user would like to learn about RFM.
Risk Factor Collection Section
[0100] The risk factor collection section collects and stores information, for example, about the user's physical characteristics, lifestyle and medical history. As the user inputs information, the user is advised if it is a positive risk factor. If the user is a follow-up user, the user may choose which information he or she wishes to modify. In particular, the user may choose to modify a physical characteristics section, a lifestyle information section, etc., as described below. If, however, the user is a first time user, the user is prompted to enter information for each of the sections.
[0101] In FIG. 5A, the physical characteristics of the user are collected and stored in, for example, a physical characteristics database. These physical characteristics include, for example, height, weight, waist size, etc.
[0102] Initially, the user is asked if the user ever has chest pain (step 501). If the user has chest pain, then the user is advised that the user needs to see a doctor soon (step 503) and step 502 is executed. If the user does not have chest pain, then step 502 is executed.
[0103] In step 502, a list of general risk factor areas, for example physical characteristics, lifestyle, and medical history is displayed. The physical characteristics section is then started (step 504) and the user is prompted to enter his or her height (step 505), weight (step 506) and waist measurement (step 507).
[0104] A body mass index (BMI) is then calculated using the information provided by the user (step 508). The BMI is determined by dividing the weight (kg) by the height (m) squared. If the weight is in pounds and the height is in inches, then the BMI is multiplied by a factor of 704.5. Information regarding the user's BMI is displayed (step 509). This information includes, for example, whether the BMI is normal, overweight or obese. A normal BMI is, for example, 18.5-24.9. A BMI of 25-29.9 may indicate that the user is overweight. A BMI of, for example, 30-34.9 may, for example, indicate that the user is level one obese. A BMI from 35-35.9 indicates that the user is level two obese. A BMI greater than, for example, 40 indicates that the user is level three obese. In addition, a user whose BMI indicates that the user is obese is advised that the user's risk of developing CAD is augmented if the user's waist measurement is greater than, for example, 40 in. or 102 c.m, for a male, or the user's waist measurement is greater than, for example, 35 in. or 88 cm, for a female.
[0105] If the user is a first time user, then the lifestyle information is started (step 512 of FIG. 5B). If the user is a follow-up user, the user is queried to select another section to update or indicate that the user is finished updating (step 511).
[0106] The user's lifestyle information is collected and stored, for example, in a lifestyle information database. Note that a follow-up user proceeds to this section only if the user selects to update his or her lifestyle information. Referring to FIG. 5B, the user is queried whether the user currently smokes (step 514). If the user does smoke, the user is advised that smoking is a risk factor for CAD (step 516) and asked a series of questions regarding his or her smoking (steps 517-520). The smoking user is queried whether the user has ever taken a structured smoking cessation class (step 517). Next, the smoking user is queried whether the user is using smoking cessation medicine (step 518). The smoking user is prompted to enter the number of years the user has smoked (step 519). Finally, the smoking user is also prompted to enter the number of packs of cigarettes the user smokes per day (step 520).
[0107] If the user is not a smoker, the user is queried if the user has smoked in the past 5 years (step 515). If the user has smoked in the past 5 years, then step 520 is executed as described above. If the user has not smoked in the past 5 years, then step 521 is executed.
[0108] In step 521, the user is queried whether the user consumes alcoholic beverages. If the user does consume alcoholic beverages, then the user is prompted to enter the number of beers (step 523), glasses of wine (step 524), and/or glasses of spirits (step 525) the user consumes per day. If the user does not consume alcoholic beverages, the user is advised that it has be shown that modest consumption of alcoholic beverages has been shown to be linked to a decreased chance of developing CAD (step 522).
[0109] Next, the user is queried whether the user consumes antioxidant vitamins, such as vitamin E, C or beta carotene (step 526). If the user does not consume antioxidant vitamins, the user is advised that antioxidant vitamins may decrease a person's risk of developing CAD (step 527). The user is then queried whether the user gets his or her recommended daily allowance (RDA) of folate, vitamin B6, and vitamin B12 (step 528). If the user does not get the RDA of these vitamins, the user is advised that there is link between a decreased risk of developing CAD and these vitamins (step 529). The user is queried whether the user consumes an aspirin a day (step 530). If the user does not consume an aspirin a day, the user is advised of the benefits of taking an aspirin a day (531).
[0110] Next, the user is prompted to enter his or her level of exercise (step 532). The level of exercise is, for example, none, low, medium, or active. The user is then queried whether the user has entered a formal exercise program (step 533) and whether the user follows American Heart Association guidelines (step 534).
[0111] Next, the user is prompted to enter his or her current level of stress, depression or hostility (step 535). The level of stress is, for example, none, low, moderate or severe. Then, the user is queried whether the user has entered a formal stress reduction program (step 536).
[0112] The user is then queried if the user is on a weight loss diet (step 538) and taking weight loss medication (step 539). If the user is a first time user, the medical history section is implemented. If the user is a follow-up user, the user is prompted to select another section to update or indicate that the user is finished updating (step 540).
[0113] Next, the user's medical history is collected and stored, for example, in a medical history database. Referring to FIG. 5C, the user is prompted to enter his or her systolic and diastolic blood pressure and is advised whether his or her blood pressure is a risk factor (step 541). The user is also queried whether the user is being treated for hypertension (step 542). Next, the user is queried whether the user has diabetes mellitus (step 543). If the user has diabetes, then the user is prompted to enter, if known, his or her blood fasting sugar (step 544). Next the diabetic user is queried whether the user is taking insulin, hypoglycemics or neither insulin nor hypoglycemics (step 545). If the diabetic user is taking insulin the user is prompted to enter his or her NPH and/or regular dose (a.m. and p.m.) (Step 546).
[0114] Steps 547-551 are performed only for female users. The female user is queried whether she has finished menopause (step 548). The female user is also queried whether her ovaries have been removed (steps 549-550). If the female user has finished menopause and/or had her ovaries removed, then the user is queried whether she is receiving hormone replacement (step 551).
[0115] Referring to FIG. 5D, steps 552-570 determine whether a user has CAD. The user is queried whether the user has known CAD (step 552). If the user has known CAD, then it is stored that the user has CAD (step 553). Next, the user is queried whether the user has ever had a heart attack (step 554). If the user has had a heart attack, then in the user is prompted to enter the date of the most recent heart attack occurred (step 555). If the heart attack occurred within the last 2 months, then the heart attack is stored as a CAD recent event (step 558). If the heart attack did not occur within the last two months, then it is stored as a CAD remote event (step 557).
[0116] Next, the user is queried whether the user has ever had coronary artery bypass surgery (step 559). If the user has had coronary artery bypass surgery, then the user is prompted to enter the date that the user had the surgery (step 560). If the surgery took place within the last six months, then it is identified as a “CAD recent event” (step 563). If the coronary artery bypass surgery did not take place within the last six months, then the surgery is identified as a “CAD remote event” (step 562). Finally, if the user that has had coronary artery bypass surgery, then the user is queried which type of conduit, such as left internal mammary artery, right internal mammary artery, vein graft, or radial artery, was used (step 564).
[0117] Next, the user is queried whether the user has had angioplasty (step 565). If the user has had angioplasty, then the user is prompted to enter the date of the angioplasty (step 566). If the user has had angioplasty within the last 2 months, then the angioplasty is stored as a CAD recent event (step 569). If the user did not have the angioplasty within the last 2 months, then the angioplasty is stored as a CAD remote event (step 568). Finally, a user who has had angioplasty is queried whether a stent was used (step 570).
[0118] Referring now to FIG. 5E, the user is queried regarding peripheral vascular disease in steps 571-580. First, the user is queried whether the user has ever had a stroke (step 571), cartoid artery disease (step 573), cartoid artery surgery (step 575), claudication (step 577), or bypass or angioplasty on his or her leg or abdominal arteries (step 579). If the user has had any of these conditions or procedures, it is recorded as peripheral vascular disease (steps 572, 574, 576, 578, 580). Next, the user is queried whether the user has left ventricular hypertophy on his or her electrocardiogram (“ECG”) (step 581). Then, the user is prompted to enter his or her homocysteine level and lipoprotein level, if known (steps 582-583). Based on these levels, the user is advised whether these levels are risk factors.
[0119] In steps 584-585, the user is queried regarding his or her family history. First, the user is queried whether the user has a family history of premature coronary artery disease (step 584). Next, the user is queried whether family members have had heart attacks or died suddenly, and the age of those family members who have had heart attacks or died suddenly (step 585).
[0120] Next, the user is queried whether the user knows his or her lipid (cholesterol) profile (step 586). If the user knows his or her lipid profile, then the user is prompted to enter his or her total cholesterol, triglycerides, HDL and LDL (step 587). If the user is a first time user, then the risk factor collection section is exited to the program. Follow-up users are prompted to select another section to update or indicate that the user has finished updating his or her profile (step 589).
[0121] FIG. 5F shows an example embodiment of a screen display shown prior to the risk factor collection section shown in FIG. 2. The screen display explains that in order to determine the user's risk for CAD, the user must provide the program with information regarding the user's lifestyle, general health, and medical history.
[0122] FIG. 5G shows an example embodiment of a screen display for the collection of a user's physical characteristics. The user is prompted to enter his or her height in feet and inches (505a) or in centimeters (505b). The user is also prompted to enter his or her weight in either pounds or kilograms (506a). The user may calculate his or her BMI by clicking on the calculator (508).
[0123] FIG. 5H shows an example embodiment of a first screen display for the collection of a user's lifestyle information. The user's responses to the queries made in the preliminary assessment of chest pain section 400, the physical characteristics portion (steps 505-508) of the risk factor collection section 500, and step 514 are shown in FIG. 5H. Since, the user has responded yes to query 514 (whether the user smokes), the user is prompted to respond to a series of queries regarding the user's smoking habits (517-520).
[0124] FIG. 5I shows an example embodiment of a second screen display for the collection of a user's lifestyle information. The user's responses to the queries made in the lifestyle portion of the risk factor collection section 500, shown in FIG. 6C, are displayed. In this screen display, the user is prompted to respond to queries 526, 528 and 530 (vitamin and aspirin intake).
Process Risk Factor Summary
[0125] In process 600, based on the information the user provided during the collection of physical characteristics, lifestyle information, and medical history, a risk factor summary is generated. Positive risk factors are factors that indicate that a user may be at risk for a disease. Positive risk factors for CAD include, for example:
[0126] 1. being a male;
[0127] 2. being a female post menopausal or a female post menopausal with ovaries removed;
[0128] 3. being a male over 40 years of age, being a female over 45 years of age;
[0129] 4. having a BMI that indicates the user is overweight;
[0130] 5. being a smoker;
[0131] 6. having diabetes mellitus;
[0132] 7. having elevated lipid levels;
[0133] 8. having known CAD;
[0134] 9. having known peripheral vascular disease;
[0135] 10. not exercising;
[0136] 11. having hypertension (high blood pressure);
[0137] 12. having feelings of stress and anxiety;
[0138] 13. having left ventricular hypertrophy (an enlarged heart);
[0139] 14. not taking anti-oxidant vitamins;
[0140] 15. having high homocysteine levels;
[0141] 16. not getting the RDA of folate, vitamin B6 or vitamin B12;
[0142] 17. having a high lipoprotein level;
[0143] 18. having a low alcohol intake;
[0144] 19. having a positive family history of coronary disease; and
[0145] 20. not taking one aspirin per day.
[0146] FIG. 6A illustrates an example embodiment of a screen display of a personal risk factor summary. The first column lists the various risk factors. The risk factors may, for example, be divided and color coded by type. The types of risk factors include, for example, type A, B, C, and D. A type A risk factor is one for which intervention has been shown to reduce the incident of CAD. Type A risk factors include, for example, smoking, dyslipidemia, high blood pressure, left ventricular hypertrophy, and aspirin intake. A type B risk factor is one for which intervention has been shown to likely reduce the incident of CAD. Type B risk factors include for example, diabetes, dyslipidemia, obesity, physical exercise, and hormone replacement therapy. A type C risk factor is one for which intervention may reduce the incidence of CAD. Type C risk factors include, for example, anger and stress, dyslipdemia, lipoprotein levels, homocysteine levels, vitamin intake, and alcohol consumption. A type D risk factor is one which cannot be modified. Type D risk factors include, for example, age, family history, known coronary disease, and known vascular disease.
[0147] The second column states whether the user is at risk for the risk factor. Subsequent columns, provide the user's status during prior implementations of the program. For example, in FIG. 6, smoking is a current risk factor for the user (601), and also was a risk factor for the user a month ago (602). Currently, not taking an aspirin a day is not a risk factor for the user (603). A month ago, however, the user was at risk for not taking an aspirin a day (604).
[0148] FIG. 6B illustrates various advisor screens displayed when a user response indicates a positive risk factor or the user has selected a positive risk factor from the risk factor summary shown in FIG. 6. The positive risk factors illustrated are being a cigarette smoker (516), not consuming any alcoholic beverages (522), not taking anti-oxidant vitamins (527), not taking an aspirin each day (530), not exercising (532), having a moderate level of stress (535), being hypertensive (542) and having a high level of homocysteine (582). The advisor includes, for example, verbiage on how to modify the risk factor.
[0149] FIGS. 6C-6T illustrates screen displays of information about a particular risk factor. These screens are displayed when the user selects (clicks on) a risk factor displayed in the personal risk factor summary shown in FIG. 6A.
Risk Factor Calculation Section
[0150] As shown in FIG. 2 (i.e., process 700), after the user's positive risk factors are displayed, if the user had neither CAD nor chest pain, then his or her risk of developing CAD is determined. The user's risk of developing CAD is determined using, for example, a conventional method, such as, the Framingham method. The Framingham method is described in the paper entitled “Assessment of Cardiovascular Risk by Use of Multiple-RiskFactor Assessment Equations,” published by the American Heart Association, Inc. and American College of Cardiology.
[0151] The Framingham method assigns risk points to various risk factors, for example, age, total cholesterol, HDL cholesterol, diabetes, and smoking. Based on the risk points the risk of an individual is determined based on information from the Framingham Heart Study.
[0152] FIG. 7A illustrates a first section of a flowchart for the calculation of risk section shown in FIG. 2. First, the risk point total is set to zero (step 701). Next, based on the sex (step 702), and age (steps 703-711, 713-721), risk points are added to the risk point total (steps 703′-711′, 713′-721′). For example, a male 41 six years old would have 1 point added to the risk point total (steps 705, 705′).
[0153] FIG. 7B illustrates a second section of a flowchart for the calculation of risk section shown in FIG. 2. After risk points are added based on age, risk points are added (steps 723′-727′, 728′-732′) to the risk point total based on the user's total cholesterol (steps 723-727, 728-732). For example, a male with a total cholesterol number of 245 would have 2 points added to his risk point total (steps 726, 726′). Thus, the 41 year old male with a total cholesterol of 245 would have a risk point total of 3 thus far.
[0154] FIG. 7C illustrates a third section of a flowchart for the calculation of risk section shown in FIG. 2. After adding risk points based on total cholesterol number, risk points are added to the risk point total (steps 733′-737, 738′-742′) based on HDL cholesterol (steps 733-737, 738-742). For example, a male with an HDL cholesterol number of 45 (step 735) would add 0 risk points to his risk point total (step 735′). Thus, the 41 year old male, with a total cholesterol of 245 and an HDL cholesterol number of 45 would have a risk point total of 3 thus far.
[0155] FIG. 7D illustrates a fourth section of a flowchart for the calculation of risk section shown in FIG. 2. In this portion of the flow chart, risk points are added based on the user's blood pressure (steps 743-747, 743′-747′, 750-754, 750-754′), whether the user has diabetes (steps 748, 748′, 755, 755′), and whether the user is a smoker (steps 749, 749′, 756, 756′). For example a male user that has a blood pressure of 125 (step 744), has diabetes (step 748) and smokes (step 749) would add 4 points (steps 744′, 748′, 749′). Thus, a 41 year old smoking male with a total cholesterol of 245, an HDL cholesterol number of 45, a blood pressure of 125, and diabetes would have a risk point total of 7.
[0156] FIG. 7E illustrates a fifth section of a flowchart for the calculation of risk section, shown in FIG. 2, for a male user. After the risk point total is calculated, the user's risk is determined and compared with a low risk population. Referring to FIG. 7E, based on the risk point total (steps 757-771) calculated in FIGS. 7A-7D the risk is determined (steps 757′-771′). Using the previous example where the risk point total was 7 for a 41 year old male, his risk of developing CAD is 13% (steps 764, 764′). In steps 772-779 and 772′-779′, this risk is compared with the low risk population. Thus, this user 13% risk is 4.3 times the risk of a low risk population of 41 year old males.
[0157] FIG. 7F illustrates a fifth section of a flowchart for the calculation of risk section, shown in FIG. 2, for a female user. FIG. 7F determines the risk that a female will develop CAD (steps 780-797, 780′-797′) and compares the risk with the low risk population (steps 701″-710″). For example, a 41 year old female user with a risk point total of 7 has a 6% chance of developing CAD (steps 787, 787′). This risk is 3 times the risk of a low risk population of 41 year old females (step 701″, 706″).
Probability of Diagnosis Section
[0158] FIG. 8 illustrates a flow chart of a probability of diagnosis (process 800) section shown in FIG. 2. This section is executed when the user opts to discuss chest pain, and determines the likelihood that the user has CAD. Information provided by the user in this section may be stored, for example, in a probability of diagnosis database. In steps 801-805, the quality, location, duration, and instigators of, and pain relievers for the chest pain are determined. Each of these determinations may trigger one of five criteria. If one or none of the criteria is met, then the chest pain is classified as non-cardiac chest pain (step 807) and step 213 is executed. If two, three or four of the criteria are met (step 809), then the user's chest pain is classified as atypical angina (step 810) and the user is advised that the user should be under a physicians care (step 811). If the user's angina meets all five of the criteria, then the user's chest pain is classified as typical angina (step 813). If a user has atypical or typical angina, then the stability of the angina is determined (step 814). If it is determined that the user's angina is unstable and not low risk unstable angina, then the user's risk of having a heart attack is determined, as described below (step 816). If it is determined in step 816 that the user has a high or intermediate risk of having a heart attack (steps 817-818), then the probability of diagnosis section 800 is exited to the main program. If the user has stable angina, low risk unstable angina (step 815), or a low risk of having a heart attack (steps 817-818), then the risk that the chest pain is CAD is determined (step 819).
[0159] Next, using the fasting blood sugar, lipid levels, and left ventricular hypertophy information collected during the medical history collection, and using hemoglobin and resting ECG information collected in step 820, a more accurate risk that user's chest pain is CAD is determined for those users that have diabetes and hyperlipidemia (step 821).
[0160] If there is a high risk that the user's chest pain is CAD (step 822), then information regarding the options available to the user's physician is displayed (step 823). If there is an intermediate risk that the user's chest pain is CAD (step 824), then the need for further testing is explained to the user (step 825). In the case of either a high or an intermediate risk (step 822, 824), a summary of the information provided by the user is outputted (step 827) and the probability of diagnosis section 800 is exited to the main program.
[0161] If there is a low risk that the user's chest pain is CAD (step 822-824), then possible causes for the chest pain are displayed (step 826). If the user has the results from a stress test (step 827), then step 827 is executed as described above. If the user does not have the results from a stress test, then probability of diagnosis section 800 is exited to the main program.
[0162] FIG. 8A illustrates a flow chart for determining the quality of a chest pain. The user is queried whether the chest pain is heavy, squeezing, constricting, pressure-like, suffocating, choking, vice-like, sharp, stabbing or tearing (steps 831-840). If the chest pain is heavy squeezing, constricting, pressure-like, suffocating, choking and/or vice-like, then the first of the five criteria has been met (steps 841-847).
[0163] FIG. 8B illustrates a flow chart for determining the location of a chest pain. The user is queried whether the chest pain is:
[0164] 1. Located in the upper breast bone (sternum) (step 848).
[0165] 2. Radiating to the jaw, or upper abdomen (step 849).
[0166] 3. Located between the shoulder blades (step 850).
[0167] 4. Located above the jaw or below the upper abdomen (step 851).
[0168] 5. Radiating to the back (step 852).
[0169] If 1, 2, and/or 3 is true, then the second of the five criteria has been met (steps 853-855).
[0170] FIG. 8C illustrates a flow chart for determining the duration of a chest pain. The user is queried whether the chest pain lasts minutes, seconds, or multiple hours (steps 856-858). If the chest pain last minutes, then the third of the five criteria has been met (step 859).
[0171] FIG. 8D illustrates a flow chart for determining what provokes a chest pain. The user is queried whether exertion, emotional stress, coughing, bending or twisting, deep palpation and/or lying down provokes the chest pain (steps 860-865). If the user responds that exertions and/or emotional stress provokes the chest pain, then the fourth of the five criteria has been met (steps 866-867).
[0172] FIG. 8E illustrates a flow chart for determining what provides relief for a chest pain. The user is queried whether rest, nitroglycerine, antacids, and/or belching offer pain relief (steps 868-872). If rest and/or nitroglycerine offer pain relief for the chest pain, then the fifth of the five criteria has been met (steps 873-874).
[0173] FIG. 8F illustrates a flow chart for determining the stability of angina (chest pain). First, the user is queried whether the user has angina now (step 875) If the user has angina, the probability of diagnosis section is exited tot he main program. If the user does not have angina now, the user is queried about when the angina first started (steps 876-879. Next, the user is queried whether his or her angina happens at night or at rest, and while the user is moving around (steps 880-882). The user is queried whether his or her angina lasts at least 15-20 minutes (step 883). Next, the user is queried whether his or her angina is increasing, makes him breathless or lightheaded, and limits his or her lifestyle (steps 883-886). Based on the user's responses in steps 875-886, the user's angina is classified as stable or unstable, and the risk of the angina leading to a heart attack is determined using Clinical Practice Guideline, Number 10, “Unstable Angina: Diagnosis and Management” published by the U.S. Department of Health and Human Services Agency for Healthcare Policy and Research.
[0174] FIG. 8G illustrates a flow chart of the step of determining the risk that the angina is CAD. The risk is determined based on information described in Table 9 of the paper entitled “ACC/AHA/ACP-ASIM Guidelines for the Management of Patients with Chronic Stable Angina” published in the Journal of the American College of Cardiology. If the user is a male with atypical angina, then he has:
[0175] a 34% risk if he is 30-39 years old (steps 819c, 819c′),
[0176] a 51% risk if he is 40-49 years old (steps 819d, 819d′),
[0177] a 65% risk if he is 50-59 years old (steps 819e, 819e′), and
[0178] a 72% risk if he is over 60 years old (steps 819f, 819f′).
[0179] If the user is a female with atypical angina, then she has:
[0180] a 12% risk if she is 30-39 years old (steps 819g, 819g′),
[0181] a 22% risk if she is 40-49 years old (steps 819h, 819h′),
[0182] a 31% risk if she is 50-59 years old (steps 819i, 819i′), and
[0183] a 51% risk if she is over 60 years old (steps 819j, 819j′).
[0184] If the user is a male with typical angina, then he has:
[0185] a 78% risk if he is 30-39 years old (steps 819l, 819l′),
[0186] a 87% risk if he is 40-49 years old (steps 819m, 819m′),
[0187] a 93% risk if he is 50-59 years old (steps 819n, 819n′), and
[0188] a 94% risk if he is over 60 years old (steps 819o, 819o′).
[0189] If the user is a female with typical angina, then she has:
[0190] a 26% risk if she is 30-39 years old (steps 819p, 819p′),
[0191] a 55% risk if she is 40-49 years old (steps 819q, 819q′),
[0192] a 73% risk if she is 50-59 years old (steps 819r, 819r′), and
[0193] a 86% risk if she is over 60 years old (steps 819s, 819s′).
[0194] FIG. 8H illustrates a flow chart for determining the risk that angina is CAD for a user that smokes and has diabetes and hyperlipidemia. The risk is determined based on information described in Table 10 of the paper entitled “ACC/AHA/ACP-ASIM Guidelines for the Management of Patients with Chronic Stable Angina” published in the Journal of the American College of Cardiology. If the user is a male with atypical angina, then he has:
[0195] a 59% risk if he is 30-39 years old (steps 821c, 821c′),
[0196] a 70% risk if he is 40-49 years old (steps 821d, 821d′),
[0197] a 79% risk if he is 50-59 years old (steps 821e, 821e′), and
[0198] a 86% risk if he is over 60 years old (steps 821f, 821f′).
[0199] If the user is a female with atypical angina, then she has:
[0200] a 39% risk if she is 30-39 years old (steps 821g, 821g′),
[0201] a 43% risk if she is 40-49 years old (steps 821h, 821h′),
[0202] a 47% risk if she is 50-59 years old (steps 821i, 821i′), and
[0203] a 51% risk if she is over 60 years old (steps 821j, 821j′).
[0204] If the user is a male with typical angina, then he has:
[0205] a 88% risk if he is 30-39 years old (steps 821l, 821l′),
[0206] a 92% risk if he is 40-49 years old (steps 821m, 821m′),
[0207] a 95% risk if he is 50-59 years old (steps 821n, 821n′), and
[0208] a 97% risk if he is over 60 years old (steps 821o, 821o′).
[0209] If the user is a female with typical angina, then she has:
[0210] a 78% risk if she is 30-39 years old (steps 821p, 821p′),
[0211] a 79% risk if she is 40-49 years old (steps 821q, 821q′),
[0212] a 82% risk if she is 50-59 years old (steps 821r, 821r′), and
[0213] a 84% risk if she is over 60 years old (steps 821s, 821s′),
Doctor's Section
[0214] FIG. 9 illustrates a flow chart of the doctor's section (process 900) shown in FIG. 2. This section is implemented if the user has an intermediate or high risk that his or her chest pain is CAD or the user's doctor wants a stress test. This section requires a physician's assistance for the user to complete. The user is queried regarding invasive and noninvasive testing. Invasive testing may include, for example, an angiogram. Noninvasive testing may include, for example, a stress test. In the first step, information regarding the user's risk of developing CAD is displayed (step 901). This information includes, for example, AHCPR information about the user's risk. Next, the user is prompted to enter information regarding left ventricular ejection fraction, stress imaging test results, exercise tolerance test results, and/or pattern of CAD if an angiogram was performed (steps 902-905).
Course of Action Section
[0215] FIG. 10 illustrates a flow chart for the course of action section shown in FIG. 2. In this section, the different courses of action, for example, pharmacological therapy, educational information, and angioplasty or surgery, are described for an individual that has CAD. The user is prompted to select a course of action (step 1001). Based on the course of action selected and the information provided by the user in doctor's section 900, a detailed description of that course of action is displayed to the user (steps 1003-1007). The detailed information includes information from, for example, the treatment section of “ACC/AHA/ACP-ASIM Guidelines for the Management of Patients with Chronic Stable Angina,” and “ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery.” After the user has finished viewing the requested course of action, the user may select another course of action to view (step 1008).
Risk Factor Modification Section
[0216] FIG. 11 illustrates a flow chart for the risk factor modification (RFM) section shown in FIG. 2. In this section, the user is advised how to modify his or her risk of developing CAD. In step 1101, RFM is described and the user is prompted to proceed to a table of personal risk factors (FIG. 6A). If the user is a first time user (step 1102), a list of personal risk factors is displayed and the user is prompted to select a risk factor for a detailed display (step 1103). If the first-time user has selected a risk factor, a detailed description of the risk factor is displayed (step 1105). If the user is not a first time user, then an interactive table of the user's personal risk factors for the current and previous sessions is displayed and the user is prompted to select a risk factor for detailed display (step 1107). If the follow-up user selects a risk factor (step 1108), then based on the current status of the risk factor as compared with the previous status of the risk factor (steps 1109, 1110), encouragement (steps 1111, 1113) or a negative warning is given (step 1112). For example if a risk factor is currently negative and was positive (step 1109), the user is encouraged to keep up the good work (step 1111). If the risk factor is currently positive and was negative (step 1110), the user is given a warning (step 1112). If the risk factor is currently negative and was negative, the user is given a warning (step 1113). If the risk factor is currently positive and was positive, the user is given continued encouragement (step 1113). After viewing a risk factor, the user can view more risk factors or continue with the remainder program (steps 1106, 1114).
Section
[0217] FIG. 12 illustrates a flow chart for the 911 section shown in FIG. 2. If the user has acute chest pain (angina now) or high risk unstable angina (step 1201), then the user is advised to call 911 (step 1202) and provided with emergency information (step 1203). The emergency information may include, for example, the nearest hospital with a cardiac care center, a list of cardiologists, and instructions to take aspirin. If the user has intermediate risk unstable angina (step 1204), then the user is advised to contact a physician (step 1205) and provided with the emergency information (step 1203). The program is exited after step 1203.
[0218] In sum, the present invention provides an effective method and system for determining an individual's risk of developing a disease. The present invention determines the risk using a user's responses to detailed question, and if the individual already has the disease, the risks associated with the disease are provided to the user. Based on the responses and established practice guidelines, the user is provided with contemporaneous feedback whether a response indicates a positive risk factor for the disease. The user is also provided with detailed information on the individual's progress on subsequent implementations of the present invention.
Claims
What is claimed is:
1. An interactive computerized method for determining the risk of an individual developing a disease and the consequences of developing the disease, comprising the steps of:
transmitting questions to a user pertaining to risk factors for the disease via a processor;
receiving responses to the questions from the user via the processor;
transmitting substantially contemporaneous feedback to the responses via the processor;
if the individual does not have the disease, determining the risk of the individual developing the disease using at least one of the responses and practice guidelines for the disease;
if the individual does have the disease, determining associated consequences of the disease using at least one of the responses and the practice guidelines for the disease;
transmitting a summary of positive risk factors and risk modification information to the user via the processor;
tracking changes in the responses and the positive risk factors for the individual over time.
2. The method according to claim 1, wherein:
the disease includes coronary artery disease.
3. The method according to claim 1, wherein:
the questions include questions about at least one of physical characteristics, lifestyle, and medical history.
4. The method according to claim 3, wherein:
at least one of:
the physical characteristics include age, gender, race, height and weight;
the lifestyle questions include questions about at least one of smoking habits, drinking habits, vitamin intake, and stress; and
the medical history Questions include questions about at least one of blood pressure, diabetes, menopause, ovary removal, hormone replacement, CAD, heart attack, coronary artery bypass surgery, angioplasty, peripheral vascular disease, left ventricular hypertophy, family history, lipid profile, stress tests, and angiograms.
5. The method according to claim 1, further comprising the step of:
determining the risk factors for the disease using the practice guidelines.
6. The method according to claim 1, wherein:
the processor operates in one of a LAN environment, WAN environment, the WWW and the Internet.
7. The method according to claim 1, wherein:
the step of receiving the responses includes storing the responses in memory.
8. The method according to claim 7, wherein:
the memory includes at least one database.
9. The method according to claim 1, wherein:
the contemporaneous feedback includes at least one of general information about at least one risk factor, and whether the risk factor is positive for the individual.
10. The method according to claim 1, wherein:
the practice guidelines include practice guidelines published by at least one of the American College of Cardiology and American Heart Association, U.S. Department of Health and Human Services Agency for Healthcare Policy and Research, and the National Heart Lung and Blood Institute.
11. The method according to claim 1, wherein:
the associated consequences include at least one of invasive intervention and noninvasive intervention.
12. The method according to claim 11, wherein:
at least one of:
the invasive intervention includes at least one of surgery and angioplasty; and
the noninvasive intervention includes at least one of pharmacological therapy and education.
13. The method according to claim 1, wherein:
the positive risk factors include being a male, being one of a postmenopausal female and a postmenopausal female with ovaries removed, being a male over 40 years of age, being a female over 45 years of age, having a BMI that indicates the user is overweight or obese, being a smoker, having diabetes mellitus, having elevated lipid levels, having known CAD, having known peripheral vascular disease, not exercising, having hypertension, having feelings of stress and anxiety, having left ventricular hypertophy, not taking anti-oxidant vitamins, having high homocysteine levels, not getting the RDA of folate, vitamin B6 or vitamin B12, having a high lipoprotein level, having a low alcohol intake, having a positive family history of coronary disease, and not taking one aspirin per day.
14. The method according to claim 1, wherein:
the risk factor modification information includes information about how to change the positive risk factors to negative risk factors.
15. The method according to claim 1, wherein:
the step of tracking includes advising the user when there has been one of a change and no change in a risk factor.
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