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name: langcare-cardiovascular-risk description: > Calculates cardiovascular risk scores including CHA2DS2-VASc, HEART Score, ASCVD Pooled Cohort Equations, and HAS-BLED from FHIR data. Generates treatment-threshold recommendations per ACC/AHA guidelines. Use when asked to assess cardiac risk, stroke risk in AFib, HEART score, CHA2DS2-VASc, ASCVD risk, or statin candidacy.

Cardiovascular Risk Assessment

When to Use This Skill

Use when a clinician needs cardiovascular risk stratification for treatment decisions including anticoagulation for AFib, statin therapy initiation, or acute chest pain evaluation.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (age, gender, race for ASCVD PCE)
2. Use fhir_search to pull active Condition resources for scoring: AFib, CHF, HTN, DM, stroke/TIA, MI, PVD
3. Use fhir_search to pull Observation resources: BP, cholesterol, HDL, LDL, HbA1c, troponin, INR, creatinine
4. Use fhir_search to pull active MedicationRequest: anticoagulants, antiplatelets, statins, antihypertensives, NSAIDs
5. Select scores based on context: AFib -> CHA2DS2-VASc + HAS-BLED; chest pain -> HEART Score; primary prevention -> ASCVD PCE
6. Calculate scores using reference tables (see references/ascvd-heart-scoring.md)
7. Use fhir_create to create RiskAssessment resource with findings and predictions
8. Present scores with treatment-threshold recommendations per ACC/AHA guidelines

FHIR Resources

• Patient -- Age, gender, race (US Core extension for ASCVD PCE)
• Condition -- CHF, HTN, DM, stroke/TIA, MI, AFib, PVD, CKD
• Observation -- BP (85354-9), cholesterol (2093-3), HDL (2085-9), LDL (18262-6), troponin (6598-7, 89579-7), INR (6301-6)
• MedicationRequest -- Anticoagulants, antiplatelets, statins, antihypertensives
• RiskAssessment -- Output: risk scores and predictions

FHIR Query Examples

Pull Active Conditions

fhir_search(resourceType="Condition", queryParams="patient=[patient-id]&clinical-status=active")

Pull Blood Pressure

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=85354-9&_sort=-date&_count=3")

Pull Lipids

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=2093-3,2085-9,18262-6&_sort=-date&_count=3")

Clinical Guidelines

• ACC/AHA 2019 Primary Prevention of Cardiovascular Disease
• ACC/AHA/HRS 2019 AFib Management (CHA2DS2-VASc thresholds)
• AHA 2021 Chest Pain Guideline (HEART Score)
• ASCVD PCE risk calculator (40-79 years)

Interpretation Guide

• CHA2DS2-VASc: 0 (male) or 1 (female) = no anticoagulation; 1 (male) = consider; >=2 = anticoagulate
• HAS-BLED >=3 = high bleeding risk, but does NOT mean withhold anticoagulation; optimize modifiable risk factors
• HEART Score: 0-3 = low risk (discharge), 4-6 = moderate (observation), 7-10 = high (admit, invasive strategy)
• ASCVD 10-year risk: <5% low, 5-7.5% borderline, 7.5-20% intermediate (statin benefit), >=20% high (statin strongly recommended)

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges