الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
The problem of ischaemic heart diseases (IHD) is still raising concern on more than one aspect: epidemiological, social, and clinical. Consequences are harsh starting from severe chest pain ending with economic burdens on patient and community.
Risk prediction using simplified tools can aid in risk quantification and stratification. Secondary attacks of IHD can be prevented, or at least predicted for proper control.
In the era of personalized medicine, identification of the patient’s condition and plan of management should be determined per individual as no one management plan fits all of the patients.
Of the calculators for secondary IHD attacks, several risk calculators and models were established. SMART risk score and SMART-REACH risk model were both developed and externally validated on patient cohorts consisting of thousands of patients. The SMART (Secondary Manifestations of Arterial Disease) study is ongoing at Utrecht Cardiovascular Centre and the REACH (Reduction of Atherothrombosis for Continued Health) registry of North America.
This study was conducted as a trial to introduce the principles of formal cardiac rehabilitation programs and the prediction of risks of secondary IHD attacks. The study aimed at improvement of the quality of life of ischaemic heart disease patients and reduce related morbidities and complications, through estimation of risks of secondary attacks risk, and vascular death, over a long period of time.
The sample size was 57 patients who were primarily diagnosed by PCI and then undergone a program of CR for one year. After thorough examination
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and investigations, SMART risk score and SMART-REACH risk model calculators were used to assess 10-year risks of IHD recurrence. Improvements and changes were also measured per patient. Follow-up was through phone calls and interviews with the researcher.
The study’s results showed the improvement of prognosis and hence, scores of SMART and SMART-REACH models in the study’s sample in addition to the reliability of scores. Risk factor occurrence, management and adherence were also measured and quantified. Those showed adherence of the patients to the programs, if not all of the items of the CR program.
Amalgamation and summarizing the study results shows that there was improvements that were noticeable per individual, even if there were trials to manage only one risk factor present. Improvements were not that evident over the study population, collectively.
Collectively, improvements were not that good when averages were calculated. Secondary IHD attack risk calculation and stratification are both essential as parts and parcels of personalized medicine in IHD patient care. No one management plan fits all.
This study was a basis for application of the use of the recent risk models for secondary