Heart 2001;85:37-43 ( January )

Cardiovascular medicine

Comparative accuracy of cardiovascular risk prediction methods in primary care patients A F Jones^a, J Walker^a, C Jewkes^a, F L Game^a, W A Bartlett^a, T Marshall^b, G R Bayly^c

^a Department of Clinical Biochemistry, Birmingham Heartlands and Solihull NHS Trust, Birmingham B9 5SS, UK, ^b Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TH, UK, ^c Department of Chemical Pathology, Bristol Royal Infirmary, Bristol BS2 8HW, UK

Correspondence to: Dr Jones JonesAla{at}heartsol.wmids.nhs.uk

Accepted 12 September 2000

OBJECTIVETo compare the relative accuracy of cardiovascular disease risk prediction methods based on equations derived from the Framingham heart study.
DESIGNRisk factor data were collected prospectively from subjects being evaluated by their primary care physicians for prevention of cardiovascular disease. Projected cardiovascular risks were calculated for each patient with the Framingham equations, and also estimated from the risk tables and charts based on the same equations.
SETTING12 primary care practices (46 doctors) in Birmingham.
PATIENTS691 subjects aged 30-70 years.
MAIN OUTCOME MEASURESSensitivity, specificity, and positive and negative predictive values of the Framingham based risk tables and charts for treatment thresholds based on projected cardiovascular disease or coronary heart disease risk.
RESULTS59 subjects (8.5%) had projected 10 year coronary heart disease risks  30%, and 291 (42.1%) had risks  15%. At equivalent projected risk levels (10 year coronary heart disease  30% and five year cardiovascular disease  20%), the original Sheffield tables and those from New Zealand have the same sensitivities (40.0%, 95% confidence interval (CI) 26.6% to 57.8% v 41.2%, 95% CI 28.7% to 57.3%) and specificities (98.6%, 95% CI 97.2% to 99.3% v 99.7%, 95% CI 98.8% to 100%). Modifications to the Sheffield tables improve sensitivity (91.4%, 95% CI 81.3% to 96.9%) but reduce specificity (95.8%, 95% CI 93.9% to 97.3%). The revised joint British recommendations' charts have high specificity (98.7%, 95% CI 97.5% to 99.5%) and good sensitivity (84.7%, 95% CI 71.0% to 93.0%).
CONCLUSIONSThe revised joint British recommendations charts appear to have the best combination of sensitivity and specificity for use in primary care patients.


Keywords: Framingham study; cardiovascular risk assessment

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© 2001 by Heart
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The sensitivity of the risk assessment tool should be the most important parameter

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