Heart Disease HealthRisk Assessment

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Medically Reviewed By: Expert-24 Medical Review Board on March 27, 2014 | References | Terms of Use & Privacy

HEALTHTOOLS™ (HEALTHRISK™ AND HEALTHAGE™) DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Expert Review Panel – Expert-24 Ltd

Terms of reference

The aim of the Expert Review Panel is to ensure that all Expert-24 clinical and epidemiological content is robust, independent and up to date.

Qualifications

Medical Director and Editor

Dr. Timothy Dudley

Chairman of the Expert Review Panel

Dr. Robin Christie

Current authors and reviewers for the Health Risk Assessment

Dr. Martin Dawes

Dr. Jonathan Mant

Emeritus authors and reviewers for the Health Risk Assessment

The following individuals were deeply involved in the creation of the health risk assessment at its inception, but are no longer active reviewers on the panel:

Dr. John Fletcher

Dr. Emma Boulton

Professor Larry Ramsay

Professor Klim McPherson



Patient-centered health risk using an Evidence Based Medicine approach

Who created it and how often is it reviewed and updated?

This health risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is: 

  • Robust - All information used is derived from reputable, referenced sources and subject to rigorous expert review. The content is written by the medical staff of Expert-24 and reviewed by an independent Expert Review Panel. All content is subject to regular review and updated to incorporate the latest evidence. Oxford Health Consulting was commissioned to conduct independent research to determine the model for disease and mortality-specific risks, the contents and its assumptions. The research and statistical modeling behind the risk assessment has been led by Dr. John Fletcher. Dr. Fletcher is deputy editor of the Canadian Medical Association Journal. He holds a Masters degree in Public Health Quantitative Methods and is a member of the Royal College of General Practitioners. 
  • Independent - The content on the site is provided by Expert-24 Limited, an independent UK company providing knowledge automation and decision support tools to improve health and wellbeing. No member of the Expert Review Panel has any financial stake in Expert-24 Ltd. Content creation and ongoing Quality Assurance is provided by Expert-24 Ltd and its Expert Review Panel. 
  • Up to date - All clinical material is subject to review by Expert-24 and its Expert Review Panel at least annually.

Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of two diseases, say bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer. 

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are: 
  • The tool gives numerical estimates of risk, rather than an imprecise statement such as "increased risk" or "reduced risk". 
  • The tool has the capability for interaction, allowing users to explore the impact on their personal risk of changing individual risk factors. 
  • The tool utilizes best available medical evidence 

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remains transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it. 

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.


How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given. 

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk. 
However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by up to 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment. 

The risk for developing heart disease in tobacco users has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). 

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is largely unknown. Therefore, the amount of risk reduction that can be expected from optimizing these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.


How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohorts, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question. 
What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgment tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. 

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgment. The judgments have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta-analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting. 

References: Coronary Heart Disease

Most recently reviewed:

  1. Mitrou P et al. Mediterranean Dietary Pattern and Prediction of All Cause Mortality in a US Population: Results from the NIH AARP Diet and Health Study. Arch Int Med. 2007; 167(22): 2461-8. 
  2. Fung T et al. Adherence to a DASH-Style Diet and Risk of CHD and Stroke in Women. Arch. Int. Med. 2008; 168(7):713-720
  3. Sinha, R et al. Meat Intake and Mortality: A Prospective Study of Over Half a Million People. Arch. Int. Med. 2009; 169(6): 562-571.
  4. Pan A, et al. Red Meat Consumption and Mortality. Results from 2 prospective cohort studies. Arch. Int. Med. Published online March 12, 2012.
  5. Magnus P et al. Controlling for High-Density Lipoprotein Cholesterol Does Not Affect the Magnitude of the Relationship Between Alcohol and Coronary Heart Disease. Circulation 2011; 124: 2296-2302.
  6. Taylor RS, Ashton KE,Moxham T, Hooper L, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease.Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD009217.
  7. Kay-Tee Khaw, et al. Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC Norfolk Prospective Population Study. PloSMedicine Jan 2008; 5(1): 0039-0047
  8. Yi TY et al. Obesity as Compared with Physical Activity in Predicting Risk of Coronary Heart Disease in Women. Circulation Jan. 31, 2006; 113(4): 499-506
  9. Holterman A et al. Risk factors for ischaemic heart disease mortality among men with different occupational physical demands. A 30 year prospective cohort study. BMJ Open 2012; 2:e000279
  10. Wijndaele K et al. Television Viewing and Incident Cardiovascular Disease: Prospective Associations and Mediation Analysis in the Epic Norfolk Study. PLOS ONE May 2011; 6(5): e20558

Guidelines reviewed annually:

  1. Prevention of cardiovascular disease at population level. National Institute for Health and Clinical Excellence. June 2010 http://www.nice.org.uk/nicemedia/live/13024/49273/49273.pdf
  2. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force, revised 2009. http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm
  3. Risk estimation and the prevention of cardiovascular disease. A national clinical guideline, revised 2007. Scottish Intercollegiate Guidelines Network
  4. http://www.sign.ac.uk/guidelines/fulltext/93-97/index.html

Articles from previous updates:

  1. Halbert SC et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol. 2010 Jan 15;105(2):198-204
  2. Lloyd-Jones DM et al. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction. The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation Feb 2, 2010: 586-613
  3. Brugts JJ, Yetgin T, Hoeks SE, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338:b2376.
  4. Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-1860.
  5. Almgren T, et al. "Stroke and coronary heart disease in treated hypertension - a prospective cohort study over three decades", J Int Med June 2005, 257(6): 496-502
  6. Viikari JS, et al. "Risk factors for coronary heart disease in children and young adults", Acta Paediatr Suppl Dec 2004, 93(446): 34-42
  7. Knekt P, et al. "Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts", Am J Clin Nutr Dec 2004, 80(6): 1508-20
  8. Kaur S, et al. "The impact of environmental tobacco smoke on women's risk of dying from heart disease: a meta-analysis", J Women's Health Oct 2004, 13(8):888-97
  9. Ciardullo AV, et al. "Non-HDL cholesterol predicts coronary heart disease in primary prevention: findings from an Italian 40-69 year old cohort in general practice", Monaldi Arch Chest Dis June 2004, 62(2):69-72
  10. Pereira MA, et al. "Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies", Arch Int Med Feb 2004 164(4):370-6
  11. Britton A, Mamot M "Different measures of alcohol consumption and risk of coronary heart diseas and all-cause mortality: 11 year follow-up of the Whitehall II Cohort Study", Addiction Jan 2004 99(1):109-16
  12. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. American Heart Association - Professional Association. 2004 Feb (revised 2007 Mar 20).
  13. Summary of recommendations for clinical preventive services. American Academy of Family Physicians - Medical Specialty Society. 1996 Nov (revised 2007 Aug).
  14. Joint British Societies (2005) JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91(Suppl 5), v1-v52.
  15. Bobrie, G. et al. Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004 Mar 17;291(11):1342-9.
  16. Cooper A, O'Flynn N. Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance. BMJ 2008;336:1246-1248.
  17. The general public 2008 NICE guideline on cholesterol is available at: http://www.nice.org.uk/nicemedia/pdf/CG67publicinfo.pdf
  18. Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients. Annals of Internal Medicine. 2009;150(12):830-39.
  19. Rissanen, T.H., "Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study", Journal of Nutrition, 01 Jan 2003, 133(1), 199-204
  20. Malyutina, S.et al, "Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study" Lancet 2002; 360: 1448-54
  21. Manson JE et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002 Sep 5;347(10):716-25
  22. Yu S. et al, Caerphilly study.What level of physical activity protects against premature cardiovascular death? The Caerphilly study. Heart 2003 May;89(5):502-6
  23. Lakka, H.M., "Abdominal obesity is associated with increased risk of acute coronary events in men", European Heart Journal, 01 May 2002; 23(9): 706-13
  24. Abbasi, F., "Relationship between obesity, insulin resistance, and coronary heart disease risk.", J Am Coll Cardiol. 04 Sep. 2002; 40(5): 937-43
  25. Kannel, W.B., "Risk stratification of obesity as a coronary risk factor.", American Journal of Cardiology, 1 Oct. 2002; 90(7): 697-701
  26. Ashton, W.D., "Body mass index and metabolic risk factors for coronary heart disease in women." European Heart Journal, 01 Jan. 2001; 22(1): 46-55
  27. Tanasescu, M., "Exercise type and intensity in relation to coronary heart disease in men." JAMA 23 Oct 2002; 288(16): 1994-2000
  28. Schnohr, P., "Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study.", European Heart Journal, 01 Apr 2002; 23(8): 620-6
  29. Orford, J.L., "A comparison of the Framingham and European Society of Cardiology coronary heart disease risk prediction models in the normative aging study." American Heart Journal, 01 Jul. 2002; 144(1): 95-100
  30. Clarke, R., "Underestimation of the importance of blood pressure and cholesterol for coronary heart disease mortality in old age." European Heart Journal, 01 Feb. 2002; 23(4): 286-93

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Some statements made available by our Services are not historical facts and therefore are considered forward-looking statements within the meaning of Section 21E of the Securities and Exchange Act of 1934. These forward looking statements are subject to risks and uncertainties as which could cause our actual results to differ materially from those expressed in or implied by the content of our Services. Forward-looking statements made available by our Services are made as of the date of the initial publication and we undertake no obligation to update any of these forward-looking statements as actual events unfold.

Third Party Payments

We are not responsible for any charges or fees associated with financial transactions that occur on or through third party websites. Any payments you may make for services you have found through use of our Services or through any Portal (such as enrolling in a class) are made exclusively through an affiliated third party website the separate privacy policy of which applies, and not through our Services or Portal. We encourage you to read the privacy statements of each and every website that collects personally identifiable information.

Privacy

We are sensitive to the expectation of privacy by those who access and use our Services. For a complete statement of our policies related to online privacy, please read our Privacy Policy, available at our Website homepage.

Choice of Law and Venue

This agreement is entered into and performed in the State of Tennessee and you agree this agreement is governed by the laws of the State of Tennessee, without consideration to the principles of the conflicts of law. Your continued use of our Services, confirms you consent and submit to the personal jurisdiction in the State of Tennessee and venue of the County of Davidson for any state or federal action arising out of the use of our Services or these Terms. This agreement does not constitute doing business in any other state than the State of Tennessee.

You agree that regardless of any statute or law to the contrary, any claim or cause of action arising out of or related to our Services, the Terms or the Privacy Policy must be filed within one year after such claim or cause of action arose or such claim or cause is barred.

Invalidity and Waiver

If any provision of these Terms is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms, which shall remain in full force and effect. No waiver of any of these Terms will be deemed a further or continuing waiver of such term or condition or any other term or condition.

Section Titles

The section titles of the Terms are merely for convenience and will not have any effect on the substantive meaning of these Terms.

Entire Agreement

Except as expressly provided in a particular "legal notice" on our Services, these Terms constitute the entire agreement between us and you, respectively, with respect to the use of our Services and content contained therein.

Additional Terms for Use of Text Message Notifications

Text Message Terms

We have developed a mobile alert and messaging service that may allow you to receive confirmation or reminders for billing purposes, medical appointments at our facilities, and other communication we may send. In addition to the mobile alert services, you may also receive additional notifications from us. By providing a mobile number that allows you to receive text message or short message reminders and information, you are opting to participate in our mobile alert and messaging service and you agree to be bound by the following terms and conditions related to our SMS text notification services.

How we Protect our Patients’ Private Information

We are dedicated to maintaining information confidentiality and complying with regulatory requirements by – among other things – limiting access to only those users that have a legitimate need to view it, and regularly educating employees on information protection.

We are committed to the care and improvement of human life, and that includes protecting your private information.

Privacy Policy

Updated as of June 13, 2016

Acceptance of Terms

Your privacy is important to us. This privacy policy (“Privacy Policy”) covers our online privacy practices with respect to use and/or disclosure of information we may collect from you when you access or use our Services. This policy does not apply to information collected through other means, such as by telephone or in person. Please review our privacy practices and contact us at privacy@hcahealthcare.com if you have questions.

By accessing and using our Services, you acknowledge and fully understand our Privacy Policy and freely consent to the information collection and use practices described in this Privacy Policy. If you do not consent to the information collection and use practices described below, you must immediately cease any access or use of our Services.

Information Collected

We collect certain information from and about our users in three ways:

Web Server Logs

When you access or use our Services, we may track information to administer our Services and analyze its usage. Examples of information we may track include:

We use this information to analyze trends, administer and improve our Services, and monitor traffic and usage patterns for information security purposes and to help make our Services more useful.

Cookies and Web Beacons

A “cookie” is a small text file that may be transferred to your computer's hard drive in order to personalize our services for you and to collect aggregate, non-personal information regarding usage of our Services by all of our users. Each computer is assigned a different cookie that contains a random, unique number. The cookie does not contain personally identifiable information. Our Services uses two different types of cookies: a “session” cookie, which is required to track a user session, for example, and which expires shortly after the session ends), and a “persistent” cookie, used to track unique visits to the Portal (defined below), as well as how the user arrived at the Portal (for example, through an email link or from a referral link), and the type of user (patient, provider, etc.). So that users are not counted twice, this cookie can “persist” anywhere from six months to two years.

Your browser software can be set to warn you of cookies or reject all cookies. Most browsers offer instructions on how to reset the browser to reject cookies in the “Help” section of the toolbar. If you reject our cookie, this may disable some of the functionality of our Services and you may not be able to use certain services.

Cookies cannot be used to run programs or deliver viruses to your computer. One of the primary purposes of cookies is to provide a convenience feature to save you time. For example, if you personalize a web page, or navigate within a website, a cookie helps the website to recall your specific information on subsequent visits. This simplifies the process of delivering relevant content and eases website navigation by providing and saving your preferences and login information as well as providing personalized functionality.

Since sponsors or partners of the website may use their own cookies when you click on a hypertext link to their website or service, you should carefully review the privacy policy of other websites to which you link from our Services.

A “web beacon,” “clear GIF,” “web bug,” or “pixel tag” is a tiny graphic file with a unique identifier that is similar in function to a cookie, but would allow us to count the number of users that have visited certain pages or screens of our websites, and to help determine the effectiveness of promotional or advertising campaigns. When used in HTML-formatted email messages, web beacons can tell the sender whether and when the email has been opened. In contrast to cookies, which may be stored on your computer's hard drive, web beacons are typically embedded invisibly on pages or screens.

We reserve the right to share aggregated site statistics monitored by cookies and web beacons with our affiliates and partner companies.

User Communications

Email communications that you send to us via the email links on our Services may be shared with a customer service representative, employee, medical expert or agent that is most able to address your inquiry. We make every effort to respond in a timely fashion once communications are received. Once we have responded to your communication, it is discarded or archived, depending on the nature of the inquiry.

The email functionality on our Services does not provide a completely secure and confidential means of communication. It is possible that your email communication may be accessed or viewed by another Internet user while in transit to us. If you wish to keep your communication private, do not use our email.

Opt-Out

We may send certain messages, including electronic newsletters, notification of account statuses, and marketing communications on a periodic basis. If you wish to be removed from such messages, you may request to discontinue future ones. All such material will have information as to how to opt-out of receiving it, although certain messages (such as a secure message sent by a doctor or an account status update), may be required and will not have opt-out capabilities.

Policy Changes

We reserves the right to change the terms of this Privacy Policy at any time by posting those changes in revisions to this Privacy Policy, so that you are always aware of our processes related to collection, use and disclosure of information. We urge you to check here for any updates to this Privacy Policy from time to time.

Information Security

No website can guarantee security, but we maintain appropriate physical, electronic, and procedural safeguards to protect your personal information collected via our Services in compliance with applicable law. Please see the Terms of Use available via the Website homepage (“Terms”) for more specific information about information security and your responsibilities.

Third Party Advertising

We may allow third party advertising companies to serve ads when you access or use our Services. These companies use non-personally identifiable information regarding your access and use of our Services and other websites, such as the user IP address, pages viewed, date and time of your visit, and number of times you have viewed an ad (but not your name, address, or other personal information), to serve ads to you on our Services and other websites that may be of interest to you. In the course of serving advertisements to our Services, our third party advertiser may place or recognize a unique cookie on your browser. In addition, we may use clear GIFs or pixel tags to help manage our online advertising. These clear GIFs enable our ad serving company to recognize a browser's cookie when a browser visits our Services. This allows us to learn which banner ads bring users to our Services. The information we collect and share through this technology is not personally identifiable.

What if I have questions or concerns regarding this Privacy Policy?

If you have any questions or concerns about this Privacy Policy or the information practices of our Services, please contact us at privacy@hcahealthcare.com.

Additional Privacy Policies for Portal

As a service to its customers, we may also provide Portals to offer some customers secure, private access to their own records at our facilities, as well as certain internet-based services which may include, among other things, assistance in finding a doctor, assistance in scheduling appointments, the ability to register for classes and pre-register for procedures, making payment for medical services rendered, and health and patient education materials (“Portal”). If you use any of our Services that include a Portal, the following additional privacy terms and protections apply.

Protected Health Information and Personally Identifiable Information

If you are one of our patients, your personal information in our possession is protected health information (“PHI”) protected by the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”), and the applicable provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act. In addition to this Privacy Policy, the HIPAA Notices of Privacy Practices of those Provider facilities apply to your PHI.

Our Services may include pages that give you the opportunity to provide us with personal identifying information (“PII”) about yourself. If you choose not to provide this information, it may limit your ability to use certain functions of the site and/or request certain services or information. The Portal can provide you with access to some of your medical records. When you seek access to those records on the Portal, we need to confirm it is you so we ask you for information such as your name and email or physical address and other information such as your date of birth (which we may also use to make sure you are eligible to use the Portal in accordance with the Terms) and the answers to “secret questions” to which only you know the answers. This information may be used to help administer your user account and in managing your account. We may need to ask you for the information again when you sign in from a new device.

We may ask for information about your location and medical needs to assist with finding a physician, and may collect and pass on information to assist you in scheduling appointments, registering for classes and pre-registering for procedures.

HIPAA Policies

In collecting your PII, our Services may also collect PHI. Just as we strive to protect your PII we are committed to protecting your PHI. If there is a breach of your PHI, we are required by law to notify you. Your PHI will remain confidential, and will only be disclosed to you or your personal representative, unless otherwise required by state or federal law. In all circumstances, unless otherwise required by law, we will obtain your written authorization before using or disclosing your PHI. This protection extends to PHI that is oral, written, or electronic.

How Else May Your Information Be Used And Disclosed?

In addition to the uses and disclosures of information outlined above, your information may also be used and disclosed as follows:

Third Party Websites and Payments

If you use the Portal to link to another third party website, you may decide to disclose personal information at that website. Please be aware that in contacting that third party website, or in providing information on that website, that third party may obtain personal information about you. This Privacy Policy does not apply when you leave the Portal and go to a third party website from the Portal. We encourage you to be aware when you leave the Portal and to read the privacy statements of each and every website that collects personally identifiable information.

Any payments you may make for services you have found on the Portal (such as enrolling in a class) are made exclusively through an affiliated third party website the separate privacy policy of which applies, and not through the Portal. We are not responsible for any fees, charges, or actions provided by such a third party website.

What can I do to protect my Privacy?

In order to protect your privacy, you should:

Please note that if you share your Portal username and password with another person, this will allow that person to see your confidential medical record information. We have no responsibility concerning any breach of your confidential medical record information due to your sharing or losing your user name or password.

Children May Not Use the Portal

We will never ask for or knowingly collect information from children, if you are a child under the age of 13, you are not permitted to use this service and should immediately exit our Services or get an adult. Consistent with the Children's Online Privacy Protection Act, we will not knowingly collect any information from children under the age of 13. Parents of un-emancipated minors may set up accounts for themselves to access their children’s medical records only as permitted pursuant to the Terms governing the Portal. If you think that we have collected personal information from a child under the age of 13 through this Portal, please contact us at privacy@hcahealthcare.com and we will dispose of the information.

What if I am accessing this Portal from outside of the United States?

If you are visiting our Portal from outside the United States, please be aware that your information may be transferred to, stored or processed in the United States, where our servers are located and our central database is operated. The data protection and other laws of the United States and other countries might not be as comprehensive as those in your country, but please be assured that we take steps to protect your privacy. By using our Portal, you understand that your information may be transferred to our facilities and those third parties with whom we share it as described in this Privacy Policy.

Connecticut Privacy Policy Notice

If collected, we will take reasonable measures to protect the confidentiality of Social Security numbers and limit access to those with a need for such information. We prohibit the unlawful disclosure of Social Security numbers.

Your California Privacy Rights

Under California Law, California residents have the right to request in writing from businesses with whom they have an established business relationship, (a) a list of the categories of personal information, such as name, e-mail and mailing address and the type of services provided to the customer, that a business has disclosed to third parties (including affiliates that are separate legal entities) during the immediately preceding calendar year for the third parties’ direct marketing purposes; and (b) the names and addresses of all such third parties. To request the above information, please contact us at privacy@hcahealthcare.com with a reference to California Disclosure Information.

We will endeavor to respond to such requests to information access within 30 days following receipt at the e-mail address stated above. If we receive your request at a different e-mail address, we will respond within a reasonable period of time, but not to exceed 150 days from the date received. Please note that we are only required to respond to each customer once per calendar year.

We treat the data of everyone who comes to our Services in accordance with this Privacy Policy, whatever their Do Not Track setting

License

Subject to the terms and conditions of these Terms of Use & Privacy Policy, Hospital grants you a non-exclusive, non-transferable license to access and use the HealthTools assessment and any reports provided to you via the HealthTools assessment solely for your personal information purposes.  Hospital and its licensors retain all intellectual property rights in the HealthTools assessment, including any reports, and any enhancements to it.  Hospital, in its sole discretion, may terminate your license to access and use the HealthTools assessment at any time, for any reason and without any prior notice; provided, that, you may continue to access and use any reports in accordance with this license that you saved outside of the HealthTools assessment.   

Reservation of Rights

Hospital and its licensors are the exclusive suppliers of the HealthTools assessment and the exclusive owners of all right, title and interest in and to the HealthTools assessment, including reports, and all intellectual property related to the HealthTools assessment, any enhancements thereto, and any materials provided to you in connection with the HealthTools assessment.  You may not use the HealthTools assessment, including reports, except pursuant to the limited rights expressly granted in these Terms of Use & Privacy Policy.

Warranties Disclaimer

Hospital provides the HealthTools assessment and reports to you via the HealthTools assessment on an “AS IS “BASIS WITHOUT ANY WARRANTIES OF ANY KIND.  TO THE FULLEST EXTENT PERMITTED BY LAW, HOSPITAL DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT AND FITNESS FOR A PARTICULAR PURPOSE.  HOSPITAL MAKES NO WARRANTIES ABOUT (i) THE ACCURACY, RELIABILITY, ACCESSIBILITY, COMPLETENESS, OR TIMELINESS OF ANY INFORMATION SUPPLIED TO YOU VIA THE HEALTHTOOLS assessment.

Limitation of Liability

IN NO EVENT SHALL HOSPITAL OR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS OR LICENSORS BE LIABLE TO YOU FOR INCIDENTAL AND CONSEQUENTIAL DAMAGES, RESULTING FROM YOUR USE OR INABILITY TO USE THE HEALTHTOOLS assessment OR ANY REPORTS OR OTHER INFORMATION PROVIDED VIA THE HEALTHTOOLS assessment, OR FOR ANY DAMAGES WHATSOEVER, WHETHER SUCH LIABILITY IS BASED ON WARRANTY, CONTRACT, TORT, NEGLIGENCE OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT HOSPITAL OR ITS LICNESORS ARE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

Responsibility for Safety

The HealthTools assessment may advocate or involve physical activity.  You hereby expressly assume all risk associated with any physical activity you undertake in connection the HealthTools assessment or any reports or other information provided via the HealthTools assessment. It is your responsibility to consult with a physician to determine your fitness to engage in any physical activities. It is also your responsibility to use appropriate equipment, clothing and techniques.

Governing Law

THIS USER AGREEMENT, AND YOUR USE AND ACCESS OF THE ASSESSMENT IS GOVERNED BY THE LAWS OF THE STATE OF COLORADO, WITHOUT REGARD TO ITS CONFLICT OF LAWS RULES. JURISDICTION AND VENUE FOR ANY CAUSE OF ACTION ARISING UNDER THIS AGREEMENT SHALL BE IN DENVER, COLORADO. “HOSPITAL” makes no representation that the Assessment is appropriate or available for use in locations outside the United States of America. You agree not to access the Assessment from any country or jurisdiction where its content is illegal or prohibited. If you choose to access the Assessment from outside the United States, you do so on your own initiative and you are responsible for compliance with local laws.

Entire Agreement

You agree that these Terms of Use & Privacy Policy set forth the entire understanding between you and Hospital with respect to the HealthTools assessment. You further agree that if any provision of these Terms of Use & Privacy Policy is held invalid, the remaining provisions shall continue in full force and effect.
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