Objective Following acute coronary syndrome (ACS), patients are managed long-term in the community, yet few tools are available to guide patient-clinician communication about risk management in that setting. We developed a score for predicting cardiovascular disease (CVD) risk among patients managed in the community after ACS.
Methods Adults aged 30–79 years with prior ACS were identified from a New Zealand primary care CVD risk management database (PREDICT) with linkage to national mortality, hospitalisation, pharmaceutical dispensing and regional laboratory data. A Cox model incorporating clinically relevant factors was developed to estimate the time to a subsequent fatal or non-fatal CVD event and transformed into a 5-year risk score. External validation was performed in patients (Coronary Disease Cohort Study) assessed 4 months post-ACS.
Results The PREDICT-ACS cohort included 13 703 patients with prior hospitalisation for ACS (median 1.9 years prior), 69% men, 58% European, median age 63 years, who experienced 3142 CVD events in the subsequent 5 years. Median estimated 5 year CVD risk was 24% (IQR 17%–35%). The validation cohort consisted of 2014 patients, 72% men, 92% European, median age 67 years, with 712 CVD events in the subsequent 5 years. Median estimated 5-year risk was 33% (IQR 24%–51%). The risk score was well calibrated in the derivation and validation cohorts, and Harrell’s c-statistic was 0.69 and 0.68, respectively.
Conclusions The PREDICT-ACS risk score uses data routinely available in community care to predict the risk of recurrent clinical events. It was derived and validated in real-world contemporary populations and can inform management decisions with patients living in the community after experiencing an ACS.
- acute coronary syndrome
- secondary prevention
- risk score
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Contributors KP, AK, RND, SW and RTJ conceived and designed the primary aim and method of this study. RTJ, SW, AK, RND, RWT and AMR designed and implemented data collection. KP, BW and NJE analysed the data. KP drafted the manuscript. All authors critically reviewed and developed the final manuscript.
Funding KP is the NZ Heart Foundation Hynds Senior Fellow, NJE holds a NZ Heart Foundation Research Fellowship, and RND holds the NZ Heart Foundation Chair of Heart Health. The PREDICT CVD study has been supported by the Health Research Council of NZ (HRC) via project grants (03/183, 08/121) and programme grants (11/800, 16/609). The CDCS (Australia NZ Clinical Trials Registry ACTRN12605000431628) was primarily funded by HRC programme grants (2002-8, 2008-14) directed by AMR, holder of the NZ Heart Foundation Chair of Cardiovascular Studies, and hosted by the Christchurch Heart Institute, University of Otago, NZ.
Competing interests Outside the submitted work, RWT reports grants from Roche Diagnostics and personal fees from Merck.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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