RT Journal Article
SR Electronic
T1 Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 891
OP 892
DO 10.1136/heartjnl-2016-310668
VO 103
IS 12
A1 Katrina K Poppe
A1 Rob N Doughty
A1 Sue Wells
A1 Dudley Gentles
A1 Harry Hemingway
A1 Rod Jackson
A1 Andrew J Kerr
YR 2017
UL http://heart.bmj.com/content/103/12/891.1.abstract
AB Objective Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients.Methods Adults aged <80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK.Results 24 927 patients, 63% men, 63% European, median age 65 years (IQR 58–72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5.0% (IQR 3.5%–8.3%). A plot of actual against predicted event rates showed very good calibration throughout the risk range. The score performed well in the UK cohort but overestimated risk for those at highest risk, who were predominantly patients defined as having heart failure.Conclusions The PREDICT-CVD secondary prevention score uses routine measurements from clinical practice that enable it to be implemented in a primary care setting. The score will facilitate risk communication between primary care practitioners and patients with prior CVD, particularly as a resource to show the benefit of risk factor modification.