Development and validation of a cardiovascular risk score for patients in the community after acute coronary syndrome

Abstract

ObjectiveFollowing 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.MethodsAdults 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.ResultsThe 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.ConclusionsThe 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.

Walking the tightrope: cardiovascular risk prediction in patients after acute coronary syndrome

“…These include the incorporation of a baseline survival hazard and the centring of the prognostic index from the derivation cohort on the mean prognostic index in the transformation of multivariable relative risk to absolute risk. Similar methodological approaches have been shown to improve model performance in the primary prevention setting and accordingly they improved the performance of the model derived by Poppe and colleagues in the present study 8 16. Future research should build on this impressive work by focusing on the external validation of this predictive model in contemporary cohorts from distinct geographical regions.…”

“…Indeed, such patients have a 20% higher absolute risk of cardiovascular disease events than patients with no history of prior cardiovascular disease. In their Heart paper, Poppe and colleagues8 tackle in an important research gap, describing the development and validation of a cardiovascular disease risk prediction model for patients with a history of prior cardiovascular disease.…”

PCSK9 inhibitors and ezetimibe with or without statin therapy for cardiovascular risk reduction: a systematic review and network meta-analysis

“…We estimated risks for individual outcomes (non-fatal myocardial infarction, non-fatal stroke, all-cause mortality, and cardiovascular mortality) over five years for primary and secondary prevention and defined four broad risk categories ranging from low to very high risk. We used medians of the risk within each risk category from the PREDICT cohort2122 as the baseline risk estimates. The risk categories were defined as low risk patient with one or two cardiovascular risk factors (risk of MACE over five years is 0-5%, median 2%); moderate risk, patients with three or four cardiovascular risk factors (risk of MACE over five years is 5-15%, median 7%); high cardiovascular risk, patients with five or more additional cardiovascular risk factors or hereditary or familial lipid disorder without any cardiovascular risk factors (the risk of MACE over five years is >15%, median 18%); and very high risk, patients with established cardiovascular disease or hereditary or familial lipid disorder (median risk of MACE over 5 years is 24%).…”

The research progress and research trends in acute coronary syndrome nursing: A review of visual analysis based on the Web of Science database

“…In recent years, with the continuous development of research methods and techniques, epidemiologic studies and studies on the construction of risk scoring systems have been increasing in the field year by year. Studies have shown that continuously improved and refined risk scoring systems help to better assist in early diagnosis and guide clinical care practices, [ 46 , 47 ] and epidemiologic studies have provided strong support for the development of more scientific prevention and treatment strategies. [ 48 , 49 ] Today, despite substantial progress in the diagnosis and treatment of ACS, cardiovascular disease remains the leading cause of death worldwide.…”